{ "hospital_name": "Roxborough Memorial Hospital", "last_updated_on": "2026-09-01", "version": "3.0", "location_name": [ "Roxborough Memorial Hospital", "Suburban Behavioral Health Campus of Roxborough Memorial Hospital" ], "hospital_address": [ "5800 Ridge Avenue Philadelphia, PA 19128", "2701 DeKalb Pike East Norriton, PA 19401" ], "license_information": { "license_number": "910401", "state": "PA" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Darshan Shawn Parekh" }, "type_2_npi": [ "1083986129", "1730451899", "1093087157" ], "standard_charge_information": [ { "description": "Hc Prq Drug Eluting Cor Revasc T Cabg B - 92938 - 48100197", "code_information": [ { "code": "92938", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10388.0, "minimum": 1038.8, "maximum": 10076.36, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 } ] } ] }, { "description": "Hc Assay Urine Urea-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 5.0, "minimum": 3.8, "maximum": 97.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14938.0, "minimum": 9000.0, "maximum": 27052.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16432.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20649.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19419.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18118.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27052.92 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15114.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18936.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13101.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15847.78, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23154.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17925.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 12597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15386.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 15685.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14938.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24355.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14938.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15187.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14938.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10106.75 } ] } ] }, { "description": "Hc Strep A Dna Quant", "code_information": [ { "code": "87652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.92, "discounted_cash": 41.0, "minimum": 28.8, "maximum": 330.6924, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 45.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.44, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.41, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 180.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 154.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.43, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 64.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.41 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 50.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 41.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Enzyme Cell Activity Radioactv, Each Specimen", "code_information": [ { "code": "82658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.4, "discounted_cash": 44.0, "minimum": 30.4, "maximum": 214.758, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 48.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 91.14, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 68.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 52.84 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.75, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.0, "discounted_cash": 18.0, "minimum": 7.96, "maximum": 509.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.38, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 31.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 26.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Renal Flow/Funct Image,Combo,Pharm", "code_information": [ { "code": "78709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2781.0, "discounted_cash": 555.0, "minimum": 185.64, "maximum": 2697.57, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 610.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1312.81, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 777.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 832.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.64 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1209.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 444.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 610.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 610.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 671.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 577.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 860.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 666.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1160.2, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 873.17, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diphtheria Antibody", "code_information": [ { "code": "86648", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.0, "discounted_cash": 15.0, "minimum": 12.168, "maximum": 123.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood Thaw Per Unit", "code_information": [ { "code": "86931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.2, "discounted_cash": 174.0, "minimum": 39.96, "maximum": 133.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 97.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 83.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITHOUT CCMCC", "code_information": [ { "code": "541", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7946.0, "minimum": 5780.9491, "maximum": 13638.18, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8741.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10410.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10330.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9133.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13638.18 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5818.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11066.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7037.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8512.61, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12317.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9536.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6766.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8185.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8344.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7946.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5821.1 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 7946.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6766.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7656.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7946.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Large Vessel(S),Limited", "code_information": [ { "code": "93979", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.0, "discounted_cash": 106.0, "minimum": 78.6, "maximum": 864.27, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 812.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 812.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 804.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vent Management, Inpatient, Initial Day", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2969.81, "discounted_cash": 631.0, "minimum": 93.5, "maximum": 2880.7157, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 694.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1493.71, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 884.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 947.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1376.15, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 505.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 93.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 978.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 757.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 650.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 663.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1320.08, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 993.49, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 631.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 713.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Antegrade Nephrostogram/Ureterogrm, Exsit Access", "code_information": [ { "code": "50431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2747.2, "discounted_cash": 712.0, "minimum": 454.38, "maximum": 2747.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 748.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 784.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1685.95, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 998.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1069.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1553.25, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 570.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2747.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1104.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 855.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 734.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 748.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1489.96, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1121.34, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 712.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 805.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Temporomandibl Disloc Complic", "code_information": [ { "code": "21485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1586.0, "minimum": 90.5, "maximum": 5036.9675, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1744.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3751.48, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2220.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2379.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3456.21, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1268.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1649.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2458.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1633.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3315.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2495.16, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1792.43, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Carpal Fx Ea Bone Wo Manip", "code_information": [ { "code": "25630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 103.0, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hemolysins/Agglutinins Auto", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 8.0, "minimum": 7.016, "maximum": 119.0772, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.02 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Program Eval Implantable In Prsn Multi Ld Pacer", "code_information": [ { "code": "93281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.1, "discounted_cash": 38.0, "minimum": 14.11, "maximum": 168.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.23, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.13, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.52, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 168.1 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 79.74, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.01, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Egd W Us Guided Fna Esph/Stomach/Douden", "code_information": [ { "code": "43238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1961.0, "minimum": 223.6, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 223.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brca1 & Brca2 Full Seq Analys/Full Dup/Del Analys", "code_information": [ { "code": "81162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 1824.0, "minimum": 288.684, "maximum": 9834.054, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 962.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.13, "discounted_cash": 5.0, "minimum": 4.176, "maximum": 369.6961, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.43, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.18 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.15 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.99, "discounted_cash": 5.0, "minimum": 4.14, "maximum": 91.1703, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.37 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "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": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.63, "discounted_cash": 14.0, "minimum": 11.68, "maximum": 406.0711, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.22, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.68 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "TRANSPLT AUTOL HCTDONOR", "code_information": [ { "code": "38241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2831.0, "discounted_cash": 1592.0, "minimum": 492.3109, "maximum": 2831.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1671.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1751.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2229.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2388.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1273.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1655.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2467.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1910.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1639.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1671.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2504.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1592.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1799.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Tarsal Disloc Wo Anes", "code_information": [ { "code": "28540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 252.0, "minimum": 118.5, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8146.0, "minimum": 4673.26, "maximum": 14020.96, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7279.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8960.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10702.4 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10590.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9390.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6933.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14020.96 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 4673.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6933.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9998.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7210.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8721.92, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12626.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9775.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6933.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8390.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8553.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8146.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6643.02 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 8146.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6933.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7871.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6933.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8146.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exhaled Air Analysis", "code_information": [ { "code": "94690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 60.0, "minimum": 4.5, "maximum": 147.9735, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 126.03, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.85, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.14, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 66.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 131.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 54.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 93.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Removal Perq Left Hrt Vad Artl/Artl&Ven Sep Insj", "code_information": [ { "code": "33992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.0, "minimum": 521.7, "maximum": 3000.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3000.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3000.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3000.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Hiv Antigen And Antibodies", "code_information": [ { "code": "87806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.3, "discounted_cash": 32.0, "minimum": 26.216, "maximum": 152.581, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 36.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 67.83, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 55.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 50.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.22 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 39.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.03, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Therapeutic Ivntj W/Focus On Cognitive Function", "code_information": [ { "code": "G0515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 34.0, "minimum": 14.75, "maximum": 147.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 147.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75.19, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 53.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 72.13, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.28, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 34.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Op Cardiac Rehab Wo Cont Ecg Monit Per Session", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.0, "discounted_cash": 131.0, "minimum": 24.8677, "maximum": 143.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 76.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 128.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc M.Pneumon Dna Quant", "code_information": [ { "code": "87582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.92, "discounted_cash": 302.0, "minimum": 102.276, "maximum": 340.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 332.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 302.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 180.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 154.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 242.1 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 311.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 317.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 340.92 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 340.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.1, "discounted_cash": 136.0, "minimum": 26.0, "maximum": 500.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan,Soft Tissue Neck,W/O Contrast", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2587.5, "discounted_cash": 106.0, "minimum": 79.0, "maximum": 2509.875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 586.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 586.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 644.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Clavicle", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.75, "discounted_cash": 88.0, "minimum": 11.5, "maximum": 435.2875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Patellr Disloc Wo Anes", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 102.0, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23241.0, "minimum": 18220.1947, "maximum": 42984.33, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 20498.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 25565.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32810.56 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30213.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 28787.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19522.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42984.33 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 22355.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 19522.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 30312.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 20303.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 24559.18, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 36024.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27889.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 19522.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23938.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 24403.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23241.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25607.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 23241.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 19522.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 24132.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19522.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23241.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us Extremity Non Vascular Real Time Ltd", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 675.0, "discounted_cash": 106.0, "minimum": 7.85, "maximum": 654.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 202.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 202.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 222.12 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA- SOI : 4", "code_information": [ { "code": "0214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49346.5, "maximum": 52307.29, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 49346.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 52307.29, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 49346.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49346.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 51813.83, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR BILIARY TRACT PROCEDURES - SOI : 2", "code_information": [ { "code": "2612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18393.0, "maximum": 19496.58, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18393.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 19496.58, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 18393.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18393.0, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19312.65, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remv Indwelling Tunneled Pleural Cath W Cuff", "code_information": [ { "code": "32552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2930.31, "discounted_cash": 641.0, "minimum": 454.38, "maximum": 2930.31, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 673.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 705.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1516.7, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 897.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1397.33, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 513.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2930.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 994.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 769.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 660.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 673.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1340.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1008.78, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 724.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS - SOI : 3", "code_information": [ { "code": "4053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19159.23, "maximum": 20308.7838, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19159.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20308.78, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19159.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19159.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20117.19, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Renal Endosc Thru Nephrostomuy/Pyelostomy W Calc Remov", "code_information": [ { "code": "50561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17420.0, "discounted_cash": 5481.0, "minimum": 776.0, "maximum": 16897.4, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8222.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11943.64, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4385.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5700.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8496.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6577.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5645.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5755.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11456.99, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8622.51, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5481.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6194.1, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5755.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6029.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12963.99, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7674.1, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9123", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30569.31, "maximum": 32403.4686, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30569.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 32403.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 30569.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30569.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32097.78, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE - SOI : 3", "code_information": [ { "code": "2453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10002.58, "maximum": 10602.7348, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10002.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10602.73, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10002.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10002.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10502.71, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Thumb Fx/Disloc W Manip", "code_information": [ { "code": "26645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1643.0, "minimum": 89.0, "maximum": 5904.487, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.25, "discounted_cash": 6.0, "minimum": 5.36, "maximum": 248.5625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11746.0, "minimum": 7200.0, "maximum": 20928.38, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10432.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12920.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15974.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15270.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 14016.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9935.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20928.38 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10601.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9935.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17725.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10332.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 12498.91, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18206.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14095.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9935.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12098.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 12333.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11746.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15694.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 11746.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9935.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11749.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9935.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11746.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Small Bowel Endo Lesion/Tumor Remov Forcps/Caut", "code_information": [ { "code": "44365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1961.0, "minimum": 180.7, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diagnostic Bone Marrow Biopsies & Aspirations", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6740.15, "discounted_cash": 2969.0, "minimum": 454.38, "maximum": 6740.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3266.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6740.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4157.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4454.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6470.37, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2375.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3088.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4602.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3563.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3058.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6206.73, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4671.18, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3355.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HIP & FEMUR FRACTURE REPAIR - SOI : 2", "code_information": [ { "code": "3082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13629.77, "maximum": 14447.5562, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13629.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 14447.56, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 13629.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13629.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14311.26, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Venogram Infer Vena Cava", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15773.5, "discounted_cash": 3227.0, "minimum": 22.5, "maximum": 15300.295, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Closed Rx Spontaneous Hip Disloc", "code_information": [ { "code": "27256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 252.0, "minimum": 173.7522, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 219.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor Vii Test", "code_information": [ { "code": "85230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.81, "discounted_cash": 17.0, "minimum": 5.0, "maximum": 628.3757, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.05, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 67.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla I&Li Low Resolution Hla-A -B&-Drb1", "code_information": [ { "code": "81371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1129.33, "discounted_cash": 404.0, "minimum": 262.69, "maximum": 1095.4501, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 444.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 606.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 837.32, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 558.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 558.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 478.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 627.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 323.62 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 296.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Protein Tot Xcpt Refractometry Serum", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.25, "discounted_cash": 3.0, "minimum": 2.936, "maximum": 83.6625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.67 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.94 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Radiother Device/Marker, Prostate", "code_information": [ { "code": "55876", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2978.0, "discounted_cash": 1415.0, "minimum": 454.38, "maximum": 2978.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1485.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1556.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2978.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1981.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2122.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2978.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1132.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2978.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1471.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2193.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1698.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1457.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1485.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2957.58, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2225.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1598.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mech Remov Pericath Obstr Cv Dev Via Ven Access", "code_information": [ { "code": "36595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4586.0, "discounted_cash": 3227.0, "minimum": 797.5054, "maximum": 4586.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4586.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4586.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4586.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4586.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4586.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4586.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp Dx Collection Specimen Brushing/Washing", "code_information": [ { "code": "43260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4793.55, "discounted_cash": 3941.0, "minimum": 410.0, "maximum": 4793.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4335.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3153.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4099.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4729.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4059.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 410.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4793.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4453.94, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Protein Tot Refractometry Any Src", "code_information": [ { "code": "84160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.01, "discounted_cash": 5.0, "minimum": 4.488, "maximum": 101.8597, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.49 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Drain Thigh/Knee Lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "discounted_cash": 2969.0, "minimum": 776.0, "maximum": 13062.214, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3266.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6843.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4157.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4454.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6470.37, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2375.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3088.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4602.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3563.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3058.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6206.73, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4671.18, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3355.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-6", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.25, "discounted_cash": 28.0, "minimum": 22.48, "maximum": 282.5125, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 58.16, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 115.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 43.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.75, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xtrnl Ecg Continuous Rhythm W/I&R Up To 48 Hrs", "code_information": [ { "code": "93227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.57, "minimum": 25.61, "maximum": 213.9529, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94 } ] } ] }, { "description": "Hc Sugars Multiple Qual", "code_information": [ { "code": "84377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.72, "discounted_cash": 5.0, "minimum": 4.4, "maximum": 101.5784, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sulfate", "code_information": [ { "code": "84392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.9, "discounted_cash": 5.0, "minimum": 3.8, "maximum": 93.993, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.39 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Tunneled Ctr Vad W/Subq Port < 5Yr", "code_information": [ { "code": "36560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5602.0, "discounted_cash": 3227.0, "minimum": 329.85, "maximum": 5602.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5602.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 329.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5602.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5602.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Optic Foramen", "code_information": [ { "code": "70190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 88.0, "minimum": 21.0, "maximum": 406.4494, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 85.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 93.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15773.5, "discounted_cash": 5688.0, "minimum": 27.5, "maximum": 15300.295, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5973.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6257.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13454.07, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7964.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8533.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12395.15, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4550.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5916.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8817.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6826.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5859.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5973.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11890.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8948.47, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6428.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Incision Exten Foot/Toe, Ea Tendon", "code_information": [ { "code": "28234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1643.0, "minimum": 776.0, "maximum": 5904.487, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Egd Diagnostic Brush Wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "discounted_cash": 927.0, "minimum": 132.7, "maximum": 6637.71, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Joint Upper Extrem W/Contrast", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3998.75, "discounted_cash": 801.0, "minimum": 307.75, "maximum": 3878.7875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1895.37, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1121.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1746.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 326.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1242.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1675.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1260.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 905.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36131.81, "maximum": 38299.7186, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 36131.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 38299.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 36131.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36131.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 37938.4, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Needle Asp Bx, Ea Add Lobe", "code_information": [ { "code": "31633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2138.34, "minimum": 371.8573, "maximum": 2138.34, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2138.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2138.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2138.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Clsd Treat Elbow Disloc Wo Anes", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 102.5, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SCHIZOPHRENIA - SOI : 3", "code_information": [ { "code": "7503", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9912.82, "maximum": 10507.5892, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9912.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10507.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9912.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9912.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10408.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES- SOI : 1", "code_information": [ { "code": "3211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13574.47, "maximum": 14388.9382, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13574.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 14388.94, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 13574.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13574.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14253.19, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Electrophys Ev,L A-V Pace/Rec,W/ Induct", "code_information": [ { "code": "93621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9107.64, "minimum": 1582.0, "maximum": 9100.28, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 9100.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9100.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 9012.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "SEIZURE - SOI : 2", "code_information": [ { "code": "0532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6292.82, "maximum": 6670.3892, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6292.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6670.39, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6292.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6292.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6607.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER CHEMOTHERAPY - SOI : 4", "code_information": [ { "code": "6964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23447.07, "maximum": 24853.8942, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 23447.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 24853.89, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 23447.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23447.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24619.42, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5084.56, "discounted_cash": 950.0, "minimum": 74.6, "maximum": 4932.0232, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1045.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2248.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1331.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1426.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2071.52, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 760.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 988.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1473.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1140.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 979.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1987.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1495.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1074.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iadna-Dna/Rna Gi Pthgn Multiplex Probe Tq 6-11", "code_information": [ { "code": "87506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1317.45, "discounted_cash": 262.0, "minimum": 181.3, "maximum": 1277.9265, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 276.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 315.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 181.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 297.18, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 289.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 544.36, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 317.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 271.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 407.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 210.39 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.59, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES - SOI : 3", "code_information": [ { "code": "2543", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9435.99, "maximum": 10002.1494, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9435.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10002.15, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9435.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9435.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9907.79, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri, Cerv Spine", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3949.78, "discounted_cash": 243.0, "minimum": 195.144, "maximum": 3831.2866, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1184.93, "10th_percentile": 1184.93, "90th_percentile": 2370.1, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Skin Test Unlisted Antigen Each", "code_information": [ { "code": "86486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.5, "discounted_cash": 29.0, "minimum": 5.22, "maximum": 63.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "714", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10384.0, "minimum": 6750.0, "maximum": 18314.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9239.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11422.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13979.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13499.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12265.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8799.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18314.72 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8263.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8799.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11401.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9151.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 11069.76, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16095.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12460.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8799.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10695.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10903.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10384.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11020.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10384.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8799.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10282.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8799.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10384.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Hemodialysis Access", "code_information": [ { "code": "93990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 821.0, "discounted_cash": 106.0, "minimum": 80.51, "maximum": 796.37, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.51 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 715.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 715.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 708.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8910.33, "maximum": 9444.9498, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8910.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9444.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8910.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8910.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9355.85, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Phys Thrp Eval, High Complexity, 45 Min", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.75, "discounted_cash": 100.0, "minimum": 63.61, "maximum": 557.5075, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 110.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 208.56, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 326.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 323.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 156.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 110.84, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 110.84, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 100.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.86, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fancc Gene Analysis Common Variant", "code_information": [ { "code": "81242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 507.0, "discounted_cash": 36.0, "minimum": 25.2, "maximum": 491.79, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75.8, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 44.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 37.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 56.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 43.94, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.94, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pml/Raralpha Common Breakpoints Qual/Quant", "code_information": [ { "code": "81315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1175.0, "discounted_cash": 207.0, "minimum": 165.848, "maximum": 1139.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 228.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 290.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 310.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 429.11, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 481.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 481.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 411.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 321.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 165.85 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 248.77, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.77, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 255.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 234.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1500-1999G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 2", "code_information": [ { "code": "6122", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28945.66, "maximum": 30682.3996, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 28945.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 30682.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 28945.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28945.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30392.94, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Amniotic Fluid Scan", "code_information": [ { "code": "82143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.0, "discounted_cash": 9.0, "minimum": 5.0, "maximum": 94.09, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins & Agglutinins, Incubated", "code_information": [ { "code": "86941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1260.0, "discounted_cash": 12.0, "minimum": 9.688, "maximum": 1222.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.07, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.42 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatomedin", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.25, "discounted_cash": 21.0, "minimum": 17.008, "maximum": 262.1425, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 23.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.01, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 69.04 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.02, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53815.0, "minimum": 9870.02, "maximum": 101647.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 47271.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 59196.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 77588.76 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 69959.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 68075.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45020.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101647.2 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 48001.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 45020.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 70469.01 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 46821.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 56636.17, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 83413.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 64578.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 45020.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 55429.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 56506.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53815.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63888.4 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 53815.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 45020.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 57066.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45020.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 53815.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9870.02 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7174.0, "minimum": 3971.93, "maximum": 12157.27, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6429.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7892.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9279.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9327.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8142.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6123.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12157.27 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 3971.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6123.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8709.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6368.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 7702.85, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11121.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8609.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6123.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7390.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 7533.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7174.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6974.76 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 7174.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6123.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6825.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6123.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7174.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5940.29 } ] } ] }, { "description": "Hc Nm Liver And Spleen Imaging", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2234.0, "discounted_cash": 408.0, "minimum": 46.5, "maximum": 2166.98, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 323.7 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 355.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% 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": 30202.0, "minimum": 6430.27, "maximum": 62418.9, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26593.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 33222.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43005.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39262.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 37732.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25327.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56340.19 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24821.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 25327.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 44061.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 26340.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 31862.12, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 46813.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36242.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 25327.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 31108.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 31712.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30202.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62418.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 30202.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 25327.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31630.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25327.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 30202.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6430.27 } ] } ] }, { "description": "Hc Hemodialysis W Sing Eval", "code_information": [ { "code": "90935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3311.66, "discounted_cash": 701.0, "minimum": 312.9165, "maximum": 5604.66, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 771.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 700.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 982.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1052.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1528.8, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 561.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 312.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 329.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1087.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 841.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 722.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 736.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1466.51, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1103.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 427.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 701.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 792.85, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 2", "code_information": [ { "code": "1782", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39897.58, "maximum": 42291.4348, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 39897.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 42291.43, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 39897.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39897.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 41892.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Elec Alys Nstim Gen Gastric Subsequent W/O Reprog", "code_information": [ { "code": "95981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.75, "discounted_cash": 60.0, "minimum": 36.76, "maximum": 264.5675, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 66.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 131.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 113.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 86.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 93.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 126.03, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.85, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19734.0, "minimum": 15367.8976, "maximum": 36255.31, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 17427.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21707.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27674.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25654.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 24281.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36255.31 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 26069.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 16597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 26139.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 17261.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 20879.66, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30588.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23681.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 16597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20326.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 20721.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19734.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19656.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 19734.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 16597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 20354.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19734.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep C Antibody, High Risk - 86803 - 30200256", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.75, "discounted_cash": 14.0, "minimum": 11.416, "maximum": 386.7875, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.54, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 61.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 52.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "NEONATAL AFTERCARE - SOI : 2", "code_information": [ { "code": "8632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19557.06, "maximum": 20730.4836, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20730.48, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20534.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Egd W Us Guided Fna Esph/Stomach/Duoden/Jejunum", "code_information": [ { "code": "43242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3690.0, "discounted_cash": 1961.0, "minimum": 267.3, "maximum": 3690.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3690.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3690.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 267.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3690.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MIGRAINE & OTHER HEADACHES - SOI : 2", "code_information": [ { "code": "0542", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6813.45, "maximum": 7222.257, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6813.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7222.26, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6813.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6813.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7154.12, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 3", "code_information": [ { "code": "2843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10754.45, "maximum": 11399.717, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10754.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11399.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10754.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10754.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11292.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fetal Biophys Prof,W/O Nst", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 817.58, "discounted_cash": 106.0, "minimum": 48.68, "maximum": 793.0526, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 304.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 334.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1500-2499G W MAJOR PROCEDURE - SOI : 4", "code_information": [ { "code": "6094", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 189063.81, "maximum": 200407.6386, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 189063.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 200407.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 189063.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 189063.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 198517.0, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 3", "code_information": [ { "code": "3423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9013.74, "maximum": 9554.5644, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9013.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.56, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9013.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9013.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9464.43, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Rheumatoid Factor Test", "code_information": [ { "code": "86430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.13, "discounted_cash": 6.0, "minimum": 4.91, "maximum": 119.4361, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 21.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.91 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Radial Head/Neck Fx Wo Manip", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 103.0, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clot Factor Wght Kininogen", "code_information": [ { "code": "85293", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.93, "discounted_cash": 18.0, "minimum": 15.14, "maximum": 224.9721, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.18, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 78.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Laryngoscopy Flex Diag", "code_information": [ { "code": "31575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.0, "discounted_cash": 204.0, "minimum": 48.5181, "maximum": 279.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 279.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 279.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 279.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 279.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 279.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 279.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 279.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 230.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gastroesophageal Reflux Exam", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1952.0, "discounted_cash": 408.0, "minimum": 32.5, "maximum": 1893.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 304.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 304.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 334.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Remove lower leg bone lesion", "code_information": [ { "code": "27635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2831.0, "discounted_cash": 3345.0, "minimum": 492.3109, "maximum": 2831.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2831.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Upper Extremity W/O Contrast", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3623.13, "discounted_cash": 243.0, "minimum": 195.144, "maximum": 3514.4361, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.86 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 272.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NON-HYPOVOLEMIC SODIUM DISORDERS - SOI : 4", "code_information": [ { "code": "4264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14607.12, "maximum": 15483.5472, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14607.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15483.55, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14607.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14607.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15337.48, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flex Transnasal With Bx Sing/Mult", "code_information": [ { "code": "43198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890.0, "discounted_cash": 927.0, "minimum": 502.571, "maximum": 2890.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERM CARDIAC PACEMAKER IMPLANT WO AMI, HEART FAILURE OR SHOCK - SOI : 1", "code_information": [ { "code": "1711", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12150.46, "maximum": 12879.4876, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12150.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12879.49, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12150.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12150.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12757.98, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13132.83, "maximum": 13920.7998, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13132.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13920.8, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 13132.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13132.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13789.47, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Us Guide Chor Vill Sampling", "code_information": [ { "code": "76945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 857.0, "minimum": 47.24, "maximum": 831.29, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.38 } ] } ] }, { "description": "Hc Iadna-Dna/Rna Gi Pthgn Multiplex Probe Tq 12-25", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2600.0, "discounted_cash": 416.0, "minimum": 287.3, "maximum": 2522.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 458.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 416.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 583.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 862.69, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 503.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 430.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 646.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 333.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 500.14 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 287.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 470.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ESOPHAGEAL DISORDERS - SOI : 3", "code_information": [ { "code": "2433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9379.26, "maximum": 9942.0156, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9379.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9942.02, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9379.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9379.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9848.22, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19539.83, "maximum": 20712.2198, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19539.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20712.22, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19539.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19539.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20516.82, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10297.0, "minimum": 5904.3, "maximum": 18148.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9163.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11327.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13852.96 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13386.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12154.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8727.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18148.44 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5904.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8727.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13128.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9076.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10978.83, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15961.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12356.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8727.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10606.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10812.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12121.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10297.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8727.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10188.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8727.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10297.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "IMPLANTABLE HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 189180.14, "maximum": 200530.9484, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 189180.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 200530.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 189180.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 189180.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 198639.15, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Revision of upper eyelid - 15822 - ", "code_information": [ { "code": "15822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6304.85, "discounted_cash": 2109.0, "minimum": 776.0, "maximum": 6115.7045, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2320.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4988.68, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2953.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3164.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4596.04, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1687.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2193.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3269.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2172.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2214.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4408.77, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3318.03, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2383.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 4", "code_information": [ { "code": "7704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12880.77, "maximum": 13653.6162, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12880.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13653.62, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12880.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12880.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13524.81, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cryptococcus Antibody", "code_information": [ { "code": "86641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.29, "discounted_cash": 14.0, "minimum": 11.528, "maximum": 199.1313, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.83, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Slp Stdy Unattnd Simul Rcord Hr/O2 Sat/Resp Flw/Resp Eff", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.5, "discounted_cash": 220.0, "minimum": 99.6447, "maximum": 616.435, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 242.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.06, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 309.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 480.97, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 216.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 164.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 342.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 264.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 227.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 461.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 347.23, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 249.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51833.32, "maximum": 54943.3192, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 51833.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 54943.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 51833.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 51833.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 54424.99, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flex Transnasal Diag Wash/Brush", "code_information": [ { "code": "43197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890.0, "discounted_cash": 927.0, "minimum": 502.571, "maximum": 2890.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "418", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16109.0, "minimum": 10601.13, "maximum": 29299.39, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17720.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22364.64 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20941.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19622.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29299.39 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13767.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20488.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14117.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 17076.22, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24969.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19330.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 13574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16592.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 16914.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16109.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19576.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 16109.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16449.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13574.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16109.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10601.13 } ] } ] }, { "description": "Hc Morph Insitu Hybridize Comput Per Spcmn Ea Add Sing Prob Stain", "code_information": [ { "code": "88373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.0, "minimum": 29.25, "maximum": 711.98, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.01 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.05 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54495.37, "maximum": 57765.0922, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 54495.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 57765.09, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 54495.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 54495.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 57220.14, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytomed, Dna, Amp Probe", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.0, "discounted_cash": 37.0, "minimum": 29.816, "maximum": 582.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 52.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.15, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 93.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 79.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 57.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.82 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 44.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eval Aud Rehab Status, 1St Hr", "code_information": [ { "code": "92626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 131.0, "minimum": 28.41, "maximum": 629.2875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 184.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.61, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 203.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 274.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.92, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Perirectal Abscess", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9087.19, "discounted_cash": 1223.0, "minimum": 776.0, "maximum": 8814.5743, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40493.0, "minimum": 7885.88, "maximum": 76085.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 35605.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 44542.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58077.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 52641.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 50956.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33910.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 76085.58 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29521.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 33910.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 48355.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 35266.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 42659.03, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 62764.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48591.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 33910.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 41707.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 42517.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40493.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34369.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 40493.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 33910.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 42715.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33910.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40493.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7885.88 } ] } ] }, { "description": "Hc Astrazeneca Covid-19 Vaccine Administration – First Dose", "code_information": [ { "code": "0021A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 4.0, "maximum": 40.0, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS - SOI : 1", "code_information": [ { "code": "2791", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4176.54, "maximum": 4427.1324, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4176.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4427.13, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4176.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4176.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4385.37, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4351.04, "maximum": 4612.1024, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4612.1, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4568.59, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hiv-1 Ag, Eia", "code_information": [ { "code": "87390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.0, "discounted_cash": 24.0, "minimum": 10.5, "maximum": 240.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.8, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 76.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 65.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 37.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS - SOI : 3", "code_information": [ { "code": "8933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10062.19, "maximum": 10665.9214, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10062.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10665.92, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10062.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10062.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10565.3, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remv Transven Pacer Electrode Single Lead", "code_information": [ { "code": "33234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12798.0, "discounted_cash": 3820.0, "minimum": 1090.5, "maximum": 12414.06, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4011.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4202.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9035.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5348.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5730.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8324.25, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3056.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3973.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5921.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4584.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3935.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4011.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7985.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6009.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4317.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ed Level 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.0, "discounted_cash": 86.0, "minimum": 52.55, "maximum": 630.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 94.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.89, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 120.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 334.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 187.84, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 68.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 630.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 630.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 630.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 189.0, "10th_percentile": 189.0, "90th_percentile": 270.0, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 387.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 133.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 380.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 180.19, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 135.61, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 86.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 97.42, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Sf Mdm 15-29 Minutes - G0463 - 76100002", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.45, "discounted_cash": 136.0, "minimum": 70.1478, "maximum": 1211.6561, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.88, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.55, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.04, "median_amount": 341.99, "10th_percentile": 341.99, "90th_percentile": 341.99, "count": "1 through 10" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.47, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.09, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Slctv Cath 1Stord W/Wo Art Punct/Fluor/S&I Bila", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8477.0, "discounted_cash": 3227.0, "minimum": 1474.1503, "maximum": 8222.69, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.25, "discounted_cash": 14.0, "minimum": 11.56, "maximum": 137.0125, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.91, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7645.0, "minimum": 3809.6, "maximum": 13059.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6841.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8409.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9968.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9938.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8746.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6515.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13059.67 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 3809.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6515.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8953.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8196.29, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11850.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9174.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6515.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7874.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8027.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7645.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5072.07 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 7645.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6515.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7331.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6515.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7645.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Smear,Primary W/Interp", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.5, "discounted_cash": 4.0, "minimum": 3.416, "maximum": 123.675, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruction Mal Lesion Trunk/Arm/Leg 2.1-3.0Cm", "code_information": [ { "code": "17263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 623.45, "discounted_cash": 205.0, "minimum": 99.0, "maximum": 623.45, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 380.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 623.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Remove/Graft Leg Bone Lesion", "code_information": [ { "code": "27638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743.0, "discounted_cash": 7418.0, "minimum": 673.0, "maximum": 7743.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39121.0, "minimum": 3979.28, "maximum": 73452.86, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 34404.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 43033.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56067.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50857.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 49193.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32765.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 73452.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32765.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 34076.43, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 41219.38, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 60637.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46945.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 32765.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40294.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 41077.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39121.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45479.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 39121.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32765.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41237.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32765.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39121.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3979.28 } ] } ] }, { "description": "Hc Hearing Aid Exam One Ear", "code_information": [ { "code": "92590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.71, "minimum": 18.0, "maximum": 307.2087, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.34 } ] } ] }, { "description": "VAGINAL DELIVERY - SOI : 1", "code_information": [ { "code": "5601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2760.42, "maximum": 2926.0452, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2760.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2926.05, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2760.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2760.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2898.44, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Egd Percutaneous Placement Gastrostomy Tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9017.71, "discounted_cash": 1961.0, "minimum": 776.0, "maximum": 8747.1787, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4639.6, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4274.44, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4100.27, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phys Thrp Re-Eval, 20 Min", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.06, "discounted_cash": 69.0, "minimum": 43.12, "maximum": 414.2482, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 76.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.96, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 136.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 134.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 107.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 76.51, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.51, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 69.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iron Binding Test", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.75, "discounted_cash": 8.0, "minimum": 5.0, "maximum": 192.7875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 36.39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.88, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Observation Direct Admission", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2443.7, "discounted_cash": 608.0, "minimum": 424.9594, "maximum": 2443.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 639.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 669.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1439.89, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 852.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 913.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1326.56, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 487.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Magellan", "plan_name": "Magellan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1082.0 }, { "payer_name": "Magellan", "plan_name": "Magellan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1082.0 }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 943.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 730.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2443.7 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 627.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 639.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1272.51, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 957.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1938.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 687.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Propoxyphene Screening - G0480 - 30100029", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.0, "discounted_cash": 114.0, "minimum": 10.185, "maximum": 890.46, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Virus Id,Inoc Test,Addnl", "code_information": [ { "code": "87253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.0, "discounted_cash": 20.0, "minimum": 16.16, "maximum": 275.48, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.16 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp Balln Dilate Biliary/Panc Duct/Ampulla Ea", "code_information": [ { "code": "43277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5196.89, "discounted_cash": 3941.0, "minimum": 776.0, "maximum": 5196.89, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4335.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3153.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4099.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4729.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4059.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5196.89, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4453.94, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 3", "code_information": [ { "code": "2313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21987.87, "maximum": 23307.1422, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 21987.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 23307.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 21987.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21987.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23087.26, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16030.0, "minimum": 10947.97, "maximum": 29148.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14184.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17633.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22249.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20839.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19521.64 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13508.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29148.7 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15154.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13508.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20856.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14048.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 16993.82, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24847.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19236.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 13508.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16511.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 16832.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16030.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20445.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 16030.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13508.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16364.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13508.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16030.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10947.97 } ] } ] }, { "description": "Hc Tumor Imaging, Mult Areas", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4236.56, "discounted_cash": 408.0, "minimum": 59.0, "maximum": 4109.4632, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 683.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 683.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 751.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diab Op Manage Individual Per 30 Min", "code_information": [ { "code": "G0108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 57.0, "minimum": 19.129, "maximum": 110.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 63.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 80.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.41 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 110.0, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 89.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 69.1, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.1, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Electron Microscopy,Diagnostic", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1792.5, "discounted_cash": 823.0, "minimum": 17.5, "maximum": 1792.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 864.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 906.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1792.5, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1153.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1235.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1792.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 658.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 584.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 584.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 500.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 856.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1276.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 397.41 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 848.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 864.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1721.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1295.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 823.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 930.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS - SOI : 2", "code_information": [ { "code": "1972", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6277.74, "maximum": 6654.4044, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6277.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6654.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6277.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6277.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6591.63, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Chromotography, Quant, Single", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1428.15, "discounted_cash": 24.0, "minimum": 19.27, "maximum": 1385.3055, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thaw Plasma Fresh Frozen Ea Unit", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.69, "discounted_cash": 174.0, "minimum": 24.91, "maximum": 109.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6254", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51887.18, "maximum": 55000.4108, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 51887.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 55000.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 51887.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 51887.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 54481.54, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bx Breast W Device Us Guide 1St Lesion", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7683.5, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 7452.995, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Laryngoscopy Indirect Diagnostic", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8360.4, "discounted_cash": 204.0, "minimum": 163.248, "maximum": 8109.588, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 224.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 482.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 285.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 306.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 444.63, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 316.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 244.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 426.51, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.99, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 230.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Arm,Deep Absc/Hematoma", "code_information": [ { "code": "23930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 2969.0, "minimum": 776.0, "maximum": 6183.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3266.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6183.1, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4157.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4454.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6183.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2375.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3088.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4602.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3563.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3058.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6183.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4671.18, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3355.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Virus, Not Specified", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 693.0, "discounted_cash": 12.0, "minimum": 8.9, "maximum": 672.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Picc W/ Sub-Q Port", "code_information": [ { "code": "36571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15105.9, "discounted_cash": 3227.0, "minimum": 1582.0, "maximum": 14652.723, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3073.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3073.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2435.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL - SOI : 4", "code_information": [ { "code": "6604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21321.46, "maximum": 22600.7476, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 21321.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 22600.75, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 21321.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21321.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22387.53, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hepatitis G Dna Dir Probe", "code_information": [ { "code": "87525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 29.0, "minimum": 20.5, "maximum": 238.2417, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 61.68, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 46.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fibrin Degradproducts,D-Dimer, Quant", "code_information": [ { "code": "85379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.63, "discounted_cash": 10.0, "minimum": 8.14, "maximum": 281.9111, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "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": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.75, "discounted_cash": 114.0, "minimum": 10.185, "maximum": 890.46, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Ribs 2 Vw Unilat", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.29, "discounted_cash": 88.0, "minimum": 16.5, "maximum": 481.4013, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 88.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS - SOI : 1", "code_information": [ { "code": "0511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5217.08, "maximum": 5530.1048, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5217.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5530.1, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5217.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5217.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5477.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Biofeedback Train Any Meth", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 16.0, "minimum": 13.416, "maximum": 123.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 123.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.71, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "104.00% 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": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Instill Via Chest Tube For Fibrinolysis, 1St Day", "code_information": [ { "code": "32561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3420.65, "discounted_cash": 641.0, "minimum": 513.04, "maximum": 3420.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 673.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 705.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1516.7, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 897.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1397.33, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 513.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3420.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 994.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 769.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 660.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 673.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1340.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1008.78, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 724.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Trach/Bronch Dilat", "code_information": [ { "code": "31630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9959.6, "discounted_cash": 3811.0, "minimum": 776.0, "maximum": 9660.812, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4002.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4192.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9014.55, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5336.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5717.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8305.05, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3964.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5907.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4573.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3925.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4002.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7966.66, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5995.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4307.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hemagglutination Inhibition", "code_information": [ { "code": "86280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 8.0, "minimum": 6.55, "maximum": 111.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.55 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Guidance Stereotactic Localization", "code_information": [ { "code": "77011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.0, "minimum": 124.1646, "maximum": 692.58, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.08 } ] } ] }, { "description": "Hc Hla Class I Typing High Resolution Complete", "code_information": [ { "code": "81379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 335.0, "minimum": 265.251, "maximum": 857.6449, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 368.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 469.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 503.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 366.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 694.2, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 778.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 778.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 519.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 268.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 402.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 345.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 352.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 402.46, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 402.46, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 413.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 378.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL ILLNESS - SOI : 3", "code_information": [ { "code": "7233", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8322.2, "maximum": 8821.532, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8322.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8821.53, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8322.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8322.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8738.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bronchoscopy Occlus&Insert Bronch Valve Init Lobe", "code_information": [ { "code": "31647", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 7215.0, "minimum": 1582.0, "maximum": 15451.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7575.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7936.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10101.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10822.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5772.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7503.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11183.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8658.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7431.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7575.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15080.25, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11349.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7215.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8152.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis Be Ab Test", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.44, "discounted_cash": 11.0, "minimum": 9.256, "maximum": 143.0168, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 50.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 42.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.03, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colonoscopy Flex Us Fna/Fnb", "code_information": [ { "code": "45392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4447.44, "discounted_cash": 1223.0, "minimum": 294.1, "maximum": 4314.0168, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert/Rplacmnt Aicd W Lead Sing/Dual", "code_information": [ { "code": "33249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91469.3, "discounted_cash": 32089.0, "minimum": 776.0, "maximum": 88725.221, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33694.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 35298.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75893.46, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44925.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48134.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 69920.16, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25671.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33373.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 49738.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38507.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33052.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 33694.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 67071.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50477.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 32089.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36261.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Microfluid Analysis, Tear Osmolarity", "code_information": [ { "code": "83861", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.58, "discounted_cash": 22.0, "minimum": 7.074, "maximum": 23.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4795.17, "maximum": 114919.5, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 86570.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 114919.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4795.17 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17874.0, "minimum": 9736.42, "maximum": 32687.29, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15799.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19662.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24950.67 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23237.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21891.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32687.29 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9736.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20173.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15648.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18928.75, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27705.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21449.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 15046.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18411.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18768.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17874.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18246.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17874.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15046.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 18351.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17874.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16363.05 } ] } ] }, { "description": "Hc Mri, Lumbar Spine", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3950.55, "discounted_cash": 243.0, "minimum": 187.2, "maximum": 3832.0335, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1185.17, "10th_percentile": 1185.17, "90th_percentile": 1185.17, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 211.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 5.0, "minimum": 4.4, "maximum": 74.69, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.98 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.26 } ] } ] }, { "description": "MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE - SOI : 2", "code_information": [ { "code": "7402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11795.71, "maximum": 12503.4526, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11795.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12503.45, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11795.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11795.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12385.5, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Transcath Stent, Cca W/Eps", "code_information": [ { "code": "37215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255.0, "minimum": 1582.0, "maximum": 15255.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15255.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15255.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Blood Draw <3 Yrs, Skilled Phys, Scalp", "code_information": [ { "code": "36405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "minimum": 23.6504, "maximum": 136.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 136.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 136.0 } ] } ] }, { "description": "ORBIT AND EYE PROCEDURES - SOI : 4", "code_information": [ { "code": "0734", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29548.87, "maximum": 31321.8022, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29548.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31321.8, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29548.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29548.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31026.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER ENDOCRINE DISORDERS - SOI : 3", "code_information": [ { "code": "4243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10468.64, "maximum": 11096.7584, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10468.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11096.76, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10468.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10468.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10992.07, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7683.5, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 7452.995, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29970.0, "minimum": 23692.7873, "maximum": 55895.05, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26390.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 32967.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42665.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38961.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 37434.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25134.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55895.05 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28397.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 25134.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 40259.08 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 26139.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 31618.82, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 46453.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35964.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 25134.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30869.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 31468.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29970.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37751.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 29970.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 25134.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31380.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25134.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29970.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34727.84 } ] } ] }, { "description": "Hc Xray Spine, Complete, 2-3 Vw", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 728.0, "discounted_cash": 106.0, "minimum": 34.34, "maximum": 706.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 82.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 2", "code_information": [ { "code": "2002", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7079.15, "maximum": 7503.899, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7079.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7503.9, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7079.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7079.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7433.11, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11741.85, "maximum": 12446.361, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11741.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12446.36, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11741.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11741.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12328.94, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prq Transluminal Coronry Mechanicl Thrombectomy", "code_information": [ { "code": "92973", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9341.0, "minimum": 177.4, "maximum": 9060.77, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE - SOI : 2", "code_information": [ { "code": "5802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3752.14, "maximum": 3977.2684, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3752.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3977.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3752.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3752.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3939.75, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "810", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10286.0, "minimum": 5720.22, "maximum": 18127.66, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9154.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11315.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13837.1 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13372.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12140.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18127.66 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5720.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11540.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9066.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10967.47, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15944.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12343.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8718.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10595.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10800.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10286.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8225.61 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10286.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8718.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10177.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8718.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10286.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel 21 Hydroxylase Deficiency", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.8, "discounted_cash": 86.0, "minimum": 69.568, "maximum": 1157.016, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 95.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.14 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 69.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 378.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 378.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 323.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.57 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 104.35 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analysis, Skeletal Muscle", "code_information": [ { "code": "88355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 174.0, "minimum": 33.32, "maximum": 495.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.92, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 99.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.34 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 364.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Pelvis/Hip,Open Bone", "code_information": [ { "code": "26992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500.0, "discounted_cash": 3345.0, "minimum": 260.85, "maximum": 1500.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 786.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1500.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Knee arthroscopysurgery - 29888 - ", "code_information": [ { "code": "29888", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7886.5, "discounted_cash": 7418.0, "minimum": 776.0, "maximum": 7886.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7886.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chromosome Analysis:20-25", "code_information": [ { "code": "88264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 861.66, "discounted_cash": 144.0, "minimum": 115.688, "maximum": 835.8102, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 159.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 144.61 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 202.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 299.33, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 115.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 538.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 538.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 461.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 224.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 115.69 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 173.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 173.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 173.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 163.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION - SOI : 3", "code_information": [ { "code": "8103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9574.59, "maximum": 10149.0654, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9574.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10149.07, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9574.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9574.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10053.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Brca1&2 185&5385&6174 Var", "code_information": [ { "code": "81212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.0, "discounted_cash": 440.0, "minimum": 141.36, "maximum": 534.0, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 453.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 462.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 528.0, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 528.0, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 497.2, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 462.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 484.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 534.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 534.0, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 352.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 300.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 257.23 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 457.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 534.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 352.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 528.0, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9867.0, "minimum": 5609.97, "maximum": 17323.98, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8787.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10854.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13223.64 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12828.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11602.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8368.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17323.98 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5679.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8368.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13792.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8703.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10528.03, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15295.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11841.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8368.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10163.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10361.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9867.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7919.24 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9867.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8368.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9725.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8368.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9867.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5609.97 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24154.0, "minimum": 10945.77, "maximum": 44735.44, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 21297.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 26569.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34147.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31400.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 29960.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44735.44 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18439.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 20283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 36438.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 21094.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 25516.64, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 37438.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28984.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 20283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 24878.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 25361.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24154.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17840.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 24154.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 20283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 25115.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20283.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24154.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10945.77 } ] } ] }, { "description": "Hc Specimen Fat Stain", "code_information": [ { "code": "89125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.0, "discounted_cash": 5.0, "minimum": 4.7, "maximum": 299.73, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOSCOPY & URETER CATHETER", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "discounted_cash": 2137.0, "minimum": 688.0, "maximum": 6637.71, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2350.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5054.22, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2991.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3205.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4656.42, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1709.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2222.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3312.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2201.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2243.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4466.69, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3361.62, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2414.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunoassay, Tumor Antigen, Ca 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.75, "discounted_cash": 20.0, "minimum": 16.648, "maximum": 241.2875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.01 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 87.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM & POST ABORTION DIAGNOSES WO PROCEDURE - SOI : 3", "code_information": [ { "code": "5613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6530.51, "maximum": 6922.3406, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6530.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6922.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6530.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6530.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6857.04, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drainage Of Kidney (Nephrostomy)", "code_information": [ { "code": "50040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3909.0, "minimum": 679.7751, "maximum": 3909.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3909.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3909.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1433.3 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1433.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Anoscopy W Biopsy Sing/Mult", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4447.44, "discounted_cash": 1223.0, "minimum": 21.2, "maximum": 4314.0168, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Repair Of Ankle Ligament - 27698 - OR36027698", "code_information": [ { "code": "27698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8493.0, "discounted_cash": 7418.0, "minimum": 776.0, "maximum": 8493.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8160.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8493.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8382.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Pregnant Uterus,Transvaginal", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 823.75, "discounted_cash": 106.0, "minimum": 53.03, "maximum": 799.0375, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 267.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunoelectrophor,Other Fluids W/Conc", "code_information": [ { "code": "86325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.0, "discounted_cash": 23.0, "minimum": 13.0, "maximum": 194.97, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 25.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.88, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 108.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 93.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 35.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.76 }, { "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": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 23.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Trigeminal", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1403.62, "discounted_cash": 313.0, "minimum": 13.0, "maximum": 1403.62, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 345.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 742.13, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 439.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 470.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 683.72, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 486.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 376.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 655.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 493.6, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1403.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 313.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Microsomal Antibody", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.5, "discounted_cash": 14.0, "minimum": 7.91, "maximum": 159.565, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us, Retroperitnl Abd, Ltd", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 900.8, "discounted_cash": 106.0, "minimum": 49.0, "maximum": 873.776, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 202.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 202.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 222.12 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 270.24, "10th_percentile": 270.24, "90th_percentile": 270.24, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us, Ob >/= 14 Wks, Add'L Fetus", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2606.63, "minimum": 42.61, "maximum": 2528.4311, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 267.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.15 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10118.0, "minimum": 7547.391, "maximum": 17805.49, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9007.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11130.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13591.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13154.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11924.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8578.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17805.49 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8871.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8578.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13354.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8921.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10791.31, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15683.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12142.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8578.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10422.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10624.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10118.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12454.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10118.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8578.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9996.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8578.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10118.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Small Bowel Endo Diag W/Wo Specimen", "code_information": [ { "code": "44360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890.0, "discounted_cash": 1961.0, "minimum": 143.6, "maximum": 2890.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2890.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2890.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2890.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2890.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2890.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2890.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Viscosity Examination", "code_information": [ { "code": "85810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.5, "discounted_cash": 11.0, "minimum": 4.0, "maximum": 128.525, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.16, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 42.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Facial Bones <3 Vw", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 622.56, "discounted_cash": 88.0, "minimum": 18.11, "maximum": 603.8832, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 133.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 147.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Path Consult In Surg,W Addn Frz Sec", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "minimum": 7.79, "maximum": 203.7, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 90.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 77.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 } ] } ] }, { "description": "NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "7943", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14202.1, "maximum": 15054.226, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14202.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15054.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14202.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14202.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14912.21, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITH CCMCC", "code_information": [ { "code": "713", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14410.0, "minimum": 11037.6922, "maximum": 26039.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12765.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15851.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19876.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18733.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17439.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12157.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26039.67 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12506.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12157.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18067.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12643.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15293.76, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22335.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17292.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 12157.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14842.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 15130.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13370.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14410.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12157.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14619.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12157.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14410.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Rays, Bone Length Studies", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 729.25, "discounted_cash": 106.0, "minimum": 20.94, "maximum": 707.3725, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.94 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 104.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 115.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6446.0, "minimum": 3516.02, "maximum": 10759.51, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 7091.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8212.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 8380.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 7205.92 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5515.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10759.51 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 3516.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 5515.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 8043.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 5736.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 6938.55, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9992.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 7735.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 5515.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 6639.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 6768.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4844.93 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 6446.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 5515.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6040.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5515.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6446.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19982.0, "minimum": 15569.7977, "maximum": 36731.63, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 17644.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21980.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28037.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25977.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 24600.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16804.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36731.63 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18751.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 16804.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 24378.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 17476.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 21140.19, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30973.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23979.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 16804.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20582.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 20981.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24803.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 19982.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 16804.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 20621.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16804.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19982.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 3", "code_information": [ { "code": "3173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16577.62, "maximum": 17572.2772, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16577.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17572.28, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16577.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16577.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17406.5, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.0, "discounted_cash": 325.0, "minimum": 121.04, "maximum": 820.62, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 358.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 325.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 674.37, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 255.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 218.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 260.64 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 390.96 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 368.15, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050.0, "discounted_cash": 64.0, "minimum": 43.52, "maximum": 1018.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 132.87, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 91.83 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 78.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.35 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 77.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 77.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10247.46, "maximum": 10862.3076, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10247.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10862.31, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10247.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10247.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10759.83, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR ANOMALY - SOI : 3", "code_information": [ { "code": "6333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22645.66, "maximum": 24004.3996, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22645.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 24004.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 22645.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22645.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23777.94, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Dna Antibody, Natv/2 Strand", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.81, "discounted_cash": 13.0, "minimum": 10.99, "maximum": 262.6857, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.44, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.99 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 1", "code_information": [ { "code": "6611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6608.07, "maximum": 7004.5542, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6608.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7004.55, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6608.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6608.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6938.47, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "IMPLANTABLE HEART ASSIST SYSTEMS- SOI : 2", "code_information": [ { "code": "1612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 108996.48, "maximum": 115536.2688, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 108996.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 115536.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 108996.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 108996.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 114446.3, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14196.36, "maximum": 15048.1416, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14196.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15048.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14196.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14196.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14906.18, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Bone Marrow Imaging Ltd Area", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 408.0, "minimum": 39.0, "maximum": 2261.6132, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 265.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 291.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIESINTRALUMINAL DEVICES", "code_information": [ { "code": "321", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25399.0, "minimum": 6726.45, "maximum": 47125.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 22388.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 27939.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35971.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33019.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 31561.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21322.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47125.67 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 26574.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 21322.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 22175.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 26823.71, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 39369.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30479.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 21322.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26161.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 26669.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25399.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34168.1 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 25399.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 21322.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 26457.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21322.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25399.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6726.45 } ] } ] }, { "description": "Hc Clsd Treat C-Mc Disloc W Manip W Anes Ea", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1643.0, "minimum": 73.5, "maximum": 5904.487, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunodiffusion", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.5, "discounted_cash": 14.0, "minimum": 11.24, "maximum": 210.975, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Peritoneal Lavage W/Wo Imaging Guidance", "code_information": [ { "code": "49084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4287.0, "discounted_cash": 927.0, "minimum": 741.784, "maximum": 4158.39, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RADIOTHERAPY - SOI : 1", "code_information": [ { "code": "6921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9479.8, "maximum": 10048.588, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9479.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10048.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9479.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9479.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9953.79, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Exc Skin Malig 0.6-1 Cm Trnk/Arm/Leg", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 723.0, "minimum": 454.38, "maximum": 2695.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Surg Path,Gross,Level I", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 29.0, "minimum": 1.5, "maximum": 140.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 69.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 41.15 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.59 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 4", "code_information": [ { "code": "2634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27710.51, "maximum": 29373.1406, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27710.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 29373.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 27710.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27710.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29096.04, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Inj,Cerv/Thorac,For Diskography", "code_information": [ { "code": "62291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4596.0, "minimum": 776.0, "maximum": 4458.12, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Injection For Lymphatic Xray", "code_information": [ { "code": "38790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1710.1, "minimum": 73.56, "maximum": 1710.1, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1710.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1710.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1710.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1710.1 } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 2", "code_information": [ { "code": "0432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12644.52, "maximum": 13403.1912, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12644.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13403.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12644.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12644.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13276.75, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24646.0, "minimum": 19363.3161, "maximum": 45681.14, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 21729.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 27111.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34869.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32041.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 30593.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45681.14 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23963.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 20694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 34033.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 21522.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 26033.81, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 38202.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29576.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 20694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 25386.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 25879.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24646.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31114.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 24646.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 20694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 25646.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24646.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10718.0, "minimum": 5108.98, "maximum": 18955.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9531.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11789.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14469.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13933.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12695.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9078.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18955.58 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7433.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9078.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13295.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9441.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 11420.17, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16613.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12861.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9078.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11039.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 11253.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10718.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9281.01 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10718.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9078.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10641.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9078.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10718.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5108.98 } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 1", "code_information": [ { "code": "3831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3836.15, "maximum": 4066.319, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3836.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4066.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3836.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3836.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4027.96, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Colonoscopy Thru Stoma Remvl Fb", "code_information": [ { "code": "44390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 950.0, "minimum": 205.4, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1045.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2248.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1331.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1426.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2071.52, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 760.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 988.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1473.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1140.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 979.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1987.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1495.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1074.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Vertebroplasty Addl Inj", "code_information": [ { "code": "22512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5944.0, "minimum": 1033.6616, "maximum": 5765.68, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "964", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14673.0, "minimum": 11252.0733, "maximum": 26545.43, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12995.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16141.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20262.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19075.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17778.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12377.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26545.43 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14665.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12377.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18206.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12872.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15570.27, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22744.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17608.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 12377.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15113.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 15407.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16283.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14673.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12377.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14903.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12377.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14673.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Microscopic Exam Of Urine", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 3.0, "minimum": 2.44, "maximum": 56.26, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.71 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTESTINAL OBSTRUCTION - SOI : 4", "code_information": [ { "code": "2474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14981.25, "maximum": 15880.125, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14981.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15880.13, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14981.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14981.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15730.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20655.0, "minimum": 4059.66, "maximum": 38022.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18233.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 22720.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29022.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26851.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 25464.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17365.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38022.01 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15150.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17365.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 26655.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18060.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 21845.8, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 32015.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24786.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 17365.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21274.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 21687.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20655.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19718.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 20655.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17365.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 21346.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17365.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20655.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 4059.66 } ] } ] }, { "description": "Hc Nm Bone Imaging, 3 Phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2546.25, "discounted_cash": 408.0, "minimum": 119.0, "maximum": 2469.8625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 657.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 657.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 722.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Angio, Abd, Combo,Incl Image Proc", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3898.53, "discounted_cash": 179.0, "minimum": 143.448, "maximum": 3781.5741, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 934.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 934.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1027.62 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 222.39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.0, "discounted_cash": 6.0, "minimum": 5.58, "maximum": 265.78, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.58 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.89, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 3", "code_information": [ { "code": "9523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17573.64, "maximum": 18628.0584, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17573.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18628.06, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17573.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17573.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18452.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Bladder W Contrast", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1489.0, "discounted_cash": 356.0, "minimum": 21.5, "maximum": 1444.33, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Removal Foot Fb Deep", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2900.0, "discounted_cash": 1688.0, "minimum": 504.31, "maximum": 8965.71, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2900.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2900.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2900.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 720.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2900.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Incision & Drain Pilonidal Cyst Complicated", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1363.4, "discounted_cash": 723.0, "minimum": 237.0953, "maximum": 1363.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1363.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1363.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 568.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1363.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Removal Fb Gum", "code_information": [ { "code": "41805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12788.8, "discounted_cash": 1586.0, "minimum": 777.0, "maximum": 12405.136, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1744.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3751.48, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2220.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2379.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3456.21, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1268.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1649.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2458.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1633.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 777.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3315.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2495.16, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1792.43, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER OPEN CRANIOTOMY- SOI : 1", "code_information": [ { "code": "0271", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14609.27, "maximum": 15485.8262, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14609.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15485.83, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14609.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14609.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15339.73, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4529.13, "maximum": 4800.8778, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4529.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4800.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4529.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4529.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4755.59, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OPIOID ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7733", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7276.63, "maximum": 7713.2278, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7276.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7713.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7276.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7276.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7640.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Physical Performance Test Ea 15 Min", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.75, "discounted_cash": 34.0, "minimum": 16.75, "maximum": 557.5075, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 48.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 72.07, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 152.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 151.07 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 599.03, "10th_percentile": 539.03, "90th_percentile": 971.93, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 53.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 34.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.35, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 4", "code_information": [ { "code": "0094", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 185457.45, "maximum": 196584.897, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 185457.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 196584.9, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 185457.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 185457.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 194730.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Image Fluid Collxn Drainag Cath Transrec/Vaginal", "code_information": [ { "code": "49407", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8656.34, "discounted_cash": 1688.0, "minimum": 184.87, "maximum": 8396.6498, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.87 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST & RESPIRATORY TRAUMA - SOI : 2", "code_information": [ { "code": "1352", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6992.97, "maximum": 7412.5482, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6992.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7412.55, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6992.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6992.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7342.62, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fine Needle Asp Wo Img Guidance", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1889.66, "discounted_cash": 415.0, "minimum": 328.6119, "maximum": 1889.66, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 457.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 982.86, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 623.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 905.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1889.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 644.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 498.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 428.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 868.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 653.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1889.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 469.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER BLADDER PROCEDURES - SOI : 4", "code_information": [ { "code": "4454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24847.39, "maximum": 26338.2334, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24847.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 26338.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24847.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24847.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26089.76, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Us Exam, Hysterosonography", "code_information": [ { "code": "76831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1099.56, "discounted_cash": 243.0, "minimum": 148.7, "maximum": 1066.5732, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES- SOI : 1", "code_information": [ { "code": "1831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29313.33, "maximum": 31072.1298, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29313.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31072.13, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29313.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29313.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30779.0, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Treat Burn 1St Degree, Initial", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.77, "discounted_cash": 205.0, "minimum": 164.088, "maximum": 948.77, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urine Bact Cult Id", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 8.0, "minimum": 6.47, "maximum": 26.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plc Cath Selective Art,Neck", "code_information": [ { "code": "36215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1954.0, "minimum": 182.3, "maximum": 1954.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1954.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1954.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1954.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1954.0 } ] } ] }, { "description": "Hc Biliary Endoscopy Percut,Dil Strict", "code_information": [ { "code": "47555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15141.0, "discounted_cash": 6618.0, "minimum": 1582.0, "maximum": 15141.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6949.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7280.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15141.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9265.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9927.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14420.72, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5294.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6883.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10258.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7942.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6816.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6949.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13833.14, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10410.8, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7478.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 4", "code_information": [ { "code": "3854", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15231.87, "maximum": 16145.7822, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15231.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16145.78, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15231.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15231.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15993.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Calculus Analysis Qual", "code_information": [ { "code": "82355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.5, "discounted_cash": 11.0, "minimum": 9.26, "maximum": 186.725, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.97 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 55.97 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 47.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Breast Loc Dev Place Mri Guide 1St Lesion", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6345.0, "discounted_cash": 723.0, "minimum": 115.58, "maximum": 6154.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.58 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath In Artery, Slctv In Pulm Art (Segmental Or Subseg)", "code_information": [ { "code": "36015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1369.36, "minimum": 121.4, "maximum": 1369.36, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1369.36 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1369.36 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1369.36 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1369.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1369.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1369.36 } ] } ] }, { "description": "Hc Moder Sedate Same Phys/Qhp Each Addl 15 Min", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.05, "minimum": 8.33, "maximum": 457.8885, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41 } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5407.19, "discounted_cash": 3227.0, "minimum": 15.0, "maximum": 5407.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5407.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5407.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5407.19, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cath Plc/Cor Angio Rs/I", "code_information": [ { "code": "93454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15442.8, "discounted_cash": 3314.0, "minimum": 1582.0, "maximum": 14979.516, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3480.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3645.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7838.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4640.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4971.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7221.55, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2651.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3446.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5137.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3977.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3413.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3480.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6927.3, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5213.48, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3745.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Elect Stimul Unattnd For Ulcers - 97014 - 42000026", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "minimum": 16.75, "maximum": 237.65, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.93 } ] } ] }, { "description": "Hc Colonoscopy,Flex,W/Control, Bleeding", "code_information": [ { "code": "45382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 1223.0, "minimum": 269.2, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Propoxyphene Screening - 80367 - 30100029", "code_information": [ { "code": "80367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.0, "minimum": 20.46, "maximum": 92.15, "payers_information": [ { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.46 } ] } ] }, { "description": "Hc Sigmoidoscopy Flex Stent W Dilate", "code_information": [ { "code": "45347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6618.67, "discounted_cash": 6206.0, "minimum": 776.0, "maximum": 6618.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6516.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4965.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6454.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6392.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6516.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6206.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [ { "code": "698", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15773.0, "minimum": 11261.82, "maximum": 28655.07, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13958.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17350.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21872.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20505.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19191.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13294.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28655.07 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11261.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13294.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 19896.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13825.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 16723.85, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24448.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18927.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 13294.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16246.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14816.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13294.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16087.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13294.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15773.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Thoracic Spine 4 Vw", "code_information": [ { "code": "72074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 106.0, "minimum": 21.5, "maximum": 765.4367, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 109.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 120.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Nose Fx W Stabil", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3389.0, "minimum": 120.76, "maximum": 10542.445, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3728.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8016.27, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4745.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5084.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7385.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2711.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3525.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5253.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4067.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3491.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 573.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7084.42, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5331.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3830.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEO BWT<500G OR 500-999G & GA<24WKS OR 500-749G W MAJ ANOM OR WOUT LIFE SUSTAINING INTERVENTION- SOI : 1", "code_information": [ { "code": "5891", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 126491.12, "maximum": 134080.5872, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 134080.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 132815.68, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21347.0, "minimum": 13091.76, "maximum": 39350.49, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18840.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 23482.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30036.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27751.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 26354.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39350.49 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 16876.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 17942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 26706.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18660.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 22572.17, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33088.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25617.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 17942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 21987.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 22414.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21347.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28994.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 21347.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 17942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 22091.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17942.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21347.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13091.76 } ] } ] }, { "description": "Hc Esophagoscopy Flexible W Bleeding Control", "code_information": [ { "code": "43227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1961.0, "minimum": 195.0, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 195.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 1", "code_information": [ { "code": "9511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9515.7, "maximum": 10086.642, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9515.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10086.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9515.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9515.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9991.49, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 9.0, "minimum": 7.0, "maximum": 143.075, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10920.0, "minimum": 7095.72, "maximum": 19343.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9709.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12012.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14765.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14196.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12954.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9246.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19343.56 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7095.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9246.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13458.59 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9616.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 11632.32, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16926.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13104.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9246.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11247.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 11466.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10920.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14361.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10920.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9246.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10859.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9246.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10920.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chemotx Admn Prtl Cavity Port/Cath", "code_information": [ { "code": "96446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548.0, "discounted_cash": 337.0, "minimum": 17.1, "maximum": 1501.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 354.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 371.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 798.63, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 472.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 506.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 735.77, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 270.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 232.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 255.58 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 351.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 523.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 405.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 347.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 354.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 531.18, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 337.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 381.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xray Hip W Pelvis, Unilat =>4 Vw", "code_information": [ { "code": "73503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 712.0, "discounted_cash": 106.0, "minimum": 27.68, "maximum": 690.64, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 104.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Heart Cntrst Eval Struct/Morph, Congen Disease", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2544.0, "discounted_cash": 356.0, "minimum": 207.38, "maximum": 2467.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 973.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 973.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1070.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 219.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Test For Porphobilinogen", "code_information": [ { "code": "84106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 5.0, "minimum": 4.656, "maximum": 58.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.92 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Post Hip Arthrplas Disloc W Anes", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1039.38, "discounted_cash": 252.0, "minimum": 180.7482, "maximum": 1039.38, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1039.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1039.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1039.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1039.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Med Nutr Ther, Subsq, Indiv, Ea 15 Min", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 22.0, "minimum": 14.6076, "maximum": 84.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.88, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelography Lumbar Inj, 2+ Regions", "code_information": [ { "code": "62305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5096.0, "discounted_cash": 801.0, "minimum": 641.128, "maximum": 4943.12, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1895.37, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1121.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1746.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1242.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1675.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1260.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 905.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plcmt Ureteral Stent, New Access W Sep Neph Cath", "code_information": [ { "code": "50695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5249.0, "discounted_cash": 3603.0, "minimum": 776.0, "maximum": 5249.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3783.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3964.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5249.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5045.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5249.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5249.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2882.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3747.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5249.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4324.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3711.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3783.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5249.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5249.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4072.16, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Of Pelvis Combo", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3648.4, "discounted_cash": 179.0, "minimum": 102.5, "maximum": 3538.948, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 910.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 910.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1000.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gas Dilut/Washout Lung Vol W/Wo Distrb Vent&Vol", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.0, "discounted_cash": 220.0, "minimum": 21.94, "maximum": 1003.95, "payers_information": [ { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 242.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.06, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 309.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.94 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 480.97, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 147.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 145.67 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 342.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 264.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 227.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 461.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 347.23, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 249.44, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Fingr Articular Fx Wo Manip Ea", "code_information": [ { "code": "26740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.0, "discounted_cash": 252.0, "minimum": 39.0, "maximum": 333.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 333.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 333.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 333.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 333.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 333.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "GASTRIC FUNDOPLICATION - SOI : 2", "code_information": [ { "code": "2322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12156.92, "maximum": 12886.3352, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12156.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12886.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12156.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12156.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12764.77, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Therapeutic Procd Strg Endur", "code_information": [ { "code": "G0237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.9, "discounted_cash": 29.0, "minimum": 18.03, "maximum": 442.223, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 69.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 161.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phospholipid Neutralization,Platelet", "code_information": [ { "code": "85597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.11, "discounted_cash": 17.0, "minimum": 14.38, "maximum": 186.3467, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.22, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES- SOI : 3", "code_information": [ { "code": "1833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39716.62, "maximum": 42099.6172, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 39716.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 42099.62, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 39716.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39716.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 41702.45, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY - SOI : 2", "code_information": [ { "code": "5012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5614.2, "maximum": 5951.052, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5614.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5951.05, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5614.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5614.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5894.91, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Lymphangiography Pelvic/Abdomin, Bilat", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16524.2, "discounted_cash": 3227.0, "minimum": 56.5, "maximum": 16028.474, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8555.0, "minimum": 3203.02, "maximum": 14805.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7637.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 9410.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11301.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11121.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9915.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14805.58 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7847.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10736.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7565.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 9150.96, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13260.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10266.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 7274.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8811.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8982.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8555.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8433.74 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 8555.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7274.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8312.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8555.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3203.02 } ] } ] }, { "description": "Hc Ct Scan,Maxillofacial Area,W/O Contrast", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2473.0, "discounted_cash": 106.0, "minimum": 77.5, "maximum": 2398.81, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 567.08 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 567.08 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 623.53 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 741.9, "10th_percentile": 741.9, "90th_percentile": 741.9, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thoracoscopy Diag Wo Biopsy", "code_information": [ { "code": "32601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20995.7, "discounted_cash": 6180.0, "minimum": 776.0, "maximum": 20365.829, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6798.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14617.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8652.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9270.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13466.69, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4944.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6427.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9579.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7416.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6365.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12917.98, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9722.05, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6983.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Of Leg Combo", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3435.0, "discounted_cash": 179.0, "minimum": 92.5, "maximum": 3331.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 854.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 854.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 939.31 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1030.5, "10th_percentile": 1030.5, "90th_percentile": 1030.5, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 98.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11510.0, "minimum": 6059.63, "maximum": 20476.32, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10226.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12661.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15629.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14963.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13713.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9739.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20476.32 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6059.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9739.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12988.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10128.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 12251.72, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17841.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13812.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9739.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11855.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 12086.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11510.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10567.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 11510.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9739.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11495.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9739.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11510.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19631.03 } ] } ] }, { "description": "Hc Clot Inhib Protein S,Total", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.29, "discounted_cash": 11.0, "minimum": 9.288, "maximum": 307.7713, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.03, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 56.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 48.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9182.0, "minimum": 3868.07, "maximum": 16009.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8187.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10100.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12220.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 11937.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10721.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7797.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16009.36 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5942.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7797.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11464.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8109.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 9809.18, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14233.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11019.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 7797.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9458.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 9641.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9182.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9384.55 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9182.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 7797.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 8987.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7797.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9182.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3868.07 } ] } ] }, { "description": "Hc Inject Nerv Blck,Stellate Ganglion", "code_information": [ { "code": "64510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 904.0, "minimum": 54.5, "maximum": 3098.8105, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 949.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 994.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2138.52, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1265.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1356.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1970.2, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 940.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1401.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 931.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 949.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1889.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1422.36, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1021.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTESTINAL OBSTRUCTION - SOI : 1", "code_information": [ { "code": "2471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3895.04, "maximum": 4128.7424, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3895.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4128.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3895.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3895.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4089.79, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Muscle Biopsy", "code_information": [ { "code": "20200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 5997.607, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Epstein-Barr Antibody,V Capsid", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.75, "discounted_cash": 18.0, "minimum": 14.51, "maximum": 168.5375, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.07 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.67 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 69.04 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fibrinogen Test - 85366 - 30500069", "code_information": [ { "code": "85366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.92, "discounted_cash": 80.0, "minimum": 11.79, "maximum": 128.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 88.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 80.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 112.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.79 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 41.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 35.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 124.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.37 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 80.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bilirubin Direct", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.76, "discounted_cash": 5.0, "minimum": 4.016, "maximum": 91.9172, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "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": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy, Nail Unit (Sep Proc)", "code_information": [ { "code": "11755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 723.0, "minimum": 454.38, "maximum": 2695.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Selenium", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.25, "discounted_cash": 25.0, "minimum": 17.6, "maximum": 198.1225, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.53 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.84, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 118.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp Remov Foreign Body/Stnt Biliary/Panc Duct", "code_information": [ { "code": "43275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5081.67, "discounted_cash": 1961.0, "minimum": 776.0, "maximum": 4929.2199, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4639.6, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4274.44, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4100.27, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Beta 2 Glycoprotein I Antibody,Ea", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 25.0, "minimum": 20.36, "maximum": 170.9625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.13 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.68, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 112.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 96.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percut Remv Kid Stone,2+ Cm", "code_information": [ { "code": "50081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37263.3, "discounted_cash": 9677.0, "minimum": 776.0, "maximum": 36145.401, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10161.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10645.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22888.45, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13548.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14516.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21086.98, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7742.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10064.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15000.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11613.37, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9968.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10161.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20227.77, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15223.39, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9677.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10935.93, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 12.6-20 Cm", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1899.6, "discounted_cash": 415.0, "minimum": 330.3404, "maximum": 1899.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 457.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 982.86, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 623.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 905.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1899.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1899.6 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1899.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1899.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 644.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 498.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 428.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 868.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 653.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1899.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 469.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chromosome Count:Addn Cells", "code_information": [ { "code": "88285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 26.0, "minimum": 21.528, "maximum": 194.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.7, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 92.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 79.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 41.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Change Of Bladder Tube,Simple", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1171.25, "discounted_cash": 255.0, "minimum": 203.6804, "maximum": 1171.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 280.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 604.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 357.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1171.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 556.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 204.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1171.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 395.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 306.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 263.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 268.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 533.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 401.78, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1171.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 288.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sars-Cov-2 Covid-19 Amp Prb", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.29, "discounted_cash": 51.0, "minimum": 35.49, "maximum": 238.9013, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 56.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.49 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 106.21, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 64.35 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 55.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 79.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.05 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 61.57, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.57, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Revasc Fem/Pop Art Angiopl/Atherectomy", "code_information": [ { "code": "37225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83101.3, "discounted_cash": 17968.0, "minimum": 587.08, "maximum": 80608.261, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18866.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19765.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42496.13, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25155.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26952.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39151.41, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14374.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18687.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27851.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21562.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18507.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18866.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 37556.16, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28264.7, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20304.33, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 42.0, "minimum": 11.16, "maximum": 67.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 43.57 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.82, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.7 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.61 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Scapula Fx Wo Manip", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1994.0, "discounted_cash": 252.0, "minimum": 73.0, "maximum": 1994.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1994.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Paravert F Jnt C/T 3Rd Lvl", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1279.0, "minimum": 222.4181, "maximum": 1279.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1279.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1279.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1279.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1279.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1279.0 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 1", "code_information": [ { "code": "9521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8197.97, "maximum": 8689.8482, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8197.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8607.87, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8197.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8689.85, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8197.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE, BIRTHWT >2499G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 4", "code_information": [ { "code": "6344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36110.26, "maximum": 38276.8756, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 36110.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 38276.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 36110.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36110.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 37915.77, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE - SOI : 1", "code_information": [ { "code": "8501", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11837.36, "maximum": 12547.6016, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11837.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12547.6, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11837.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11837.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12429.23, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Psych Diagnostic Evaluation", "code_information": [ { "code": "90791", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 782.75, "discounted_cash": 181.0, "minimum": 110.62, "maximum": 759.2675, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 199.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 429.16, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 395.38, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 590.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 281.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 190.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 379.27, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 285.44, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES - SOI : 3", "code_information": [ { "code": "2283", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14409.64, "maximum": 15274.2184, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14409.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15274.22, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14409.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14409.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15130.12, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Mercury", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 16.0, "minimum": 12.0, "maximum": 164.9, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.66, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.01 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Screen Quant Alcohols Biomarkers 1 Or 2 - G0480 - 31080321", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.3, "discounted_cash": 114.0, "minimum": 10.185, "maximum": 890.46, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Test Def 15-21 Classes", "code_information": [ { "code": "G0482", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.0, "discounted_cash": 198.0, "minimum": 132.82, "maximum": 806.07, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 218.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 198.74 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 278.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.82 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.37, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 221.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 189.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 308.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 158.99 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 238.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 204.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 238.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 238.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pathology Clinical Consultation Mod Mdm 21-40Min", "code_information": [ { "code": "80504", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 761.6, "discounted_cash": 174.0, "minimum": 41.99, "maximum": 738.752, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.92, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.99 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 364.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pinworm Exam", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 4.0, "minimum": 2.9, "maximum": 99.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Repair Achilles Tendon", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9993.0, "discounted_cash": 7418.0, "minimum": 776.0, "maximum": 9993.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8160.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8901.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9993.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8382.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CHEMOTHERAPY - SOI : 2", "code_information": [ { "code": "6962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7843.94, "maximum": 8314.5764, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7843.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8314.58, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7843.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7843.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8236.14, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Tarsal Fx W Manip Ea", "code_information": [ { "code": "28455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 1643.0, "minimum": 127.0, "maximum": 11825.949, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39342.0, "minimum": 3982.8, "maximum": 73877.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 34597.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 43276.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56391.53 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51144.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 49477.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 73877.21 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 3982.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 34268.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 41451.48, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 60980.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 47210.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 32950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40522.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 41309.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39342.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5507.33 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 39342.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41475.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 39342.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6890.51 } ] } ] }, { "description": "Hc Intra-Atrial Recording", "code_information": [ { "code": "93602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25032.0, "discounted_cash": 7973.0, "minimum": 1223.11, "maximum": 24281.04, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8372.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8771.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18858.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11163.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11960.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17374.11, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6379.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1235.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1235.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1223.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8292.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12359.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9568.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8213.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 8372.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16666.19, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12542.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7973.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9010.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood/Lymph System Procedure", "code_information": [ { "code": "38999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1914.5, "discounted_cash": 451.0, "minimum": 332.9316, "maximum": 1914.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 496.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1066.68, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 631.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 676.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 982.73, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 360.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1914.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 469.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 699.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 541.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 464.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 473.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 942.69, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 709.46, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1914.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 451.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 509.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Nose/Jaw Fracw Dent Wires Fix", "code_information": [ { "code": "21345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1586.0, "minimum": 454.5, "maximum": 5036.9675, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 481.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1649.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2458.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1633.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3315.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2495.16, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1792.43, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1744.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3751.48, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2220.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2379.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3456.21, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1268.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 } ] } ] }, { "description": "Hc Collection Capillary Blood Specimen", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "minimum": 1.8, "maximum": 29.1, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 1.8 } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.0, "discounted_cash": 11.0, "minimum": 8.928, "maximum": 206.61, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 42.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Up Extrem Art Bilat", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2967.25, "discounted_cash": 243.0, "minimum": 119.34, "maximum": 2878.2325, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1137.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1137.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1126.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biliary End Prq T-Tube Dx W/ Collect Spec Brush", "code_information": [ { "code": "47552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15141.0, "discounted_cash": 6618.0, "minimum": 1999.25, "maximum": 15141.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6949.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7280.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15141.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9265.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9927.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14420.72, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5294.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6883.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10258.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7942.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6816.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6949.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13833.14, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10410.8, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7478.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Elbow 2 Vw", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.61, "discounted_cash": 88.0, "minimum": 11.5, "maximum": 417.6917, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 70.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 77.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Ilioinguinal, Iliohypogastr", "code_information": [ { "code": "64425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 721.0, "minimum": 35.0, "maximum": 2459.8715, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 793.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1706.71, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1010.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1082.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1572.38, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 577.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 750.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1118.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 865.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 757.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1508.31, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1135.15, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 815.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11993.0, "minimum": 5438.2, "maximum": 21402.97, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10648.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13192.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16337.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15591.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 14334.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21402.97 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10238.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14414.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10547.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 12758.38, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18590.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14392.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12353.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 12593.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11993.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16100.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 11993.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12015.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10141.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11993.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5438.2 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7784.0, "minimum": 5648.7963, "maximum": 13326.41, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6962.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8562.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10172.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10119.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8925.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6631.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13326.41 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5800.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6631.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9061.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6896.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.14, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12065.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9341.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6631.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8017.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8173.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7784.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10024.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 7784.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6631.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7481.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6631.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7784.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla Crossmatch Noncytotoxic Ea+ Serum/Dilution", "code_information": [ { "code": "86826", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.2, "discounted_cash": 36.0, "minimum": 29.22, "maximum": 332.904, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 40.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.53 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 51.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 75.61, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 62.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 56.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Abd/Pel Vasc Study,Complete", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1555.69, "discounted_cash": 243.0, "minimum": 119.34, "maximum": 1509.0193, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1448.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc R Hrt Cath Chd W/Img Cath Trgt Zon Abnl Nt Connj", "code_information": [ { "code": "93594", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3314.0, "minimum": 1582.0, "maximum": 14363.372, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3480.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3645.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7838.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4640.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4971.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7221.55, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2651.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6568.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6568.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 6568.56 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3446.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5137.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3977.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3413.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3480.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6927.3, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5213.48, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3314.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3745.17, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep A Antibody Total", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 12.0, "minimum": 9.91, "maximum": 153.9875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.65, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 53.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.87 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bx Breast W Device Us Guide Addl Lesion", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11936.0, "minimum": 66.12, "maximum": 11577.92, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Candida Dna Dir Probe", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.0, "discounted_cash": 20.0, "minimum": 16.04, "maximum": 170.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.66, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Colon Air Contrast", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1392.5, "discounted_cash": 179.0, "minimum": 39.0, "maximum": 1350.725, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 326.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 358.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Low Dose, Lung Cancer Screen", "code_information": [ { "code": "G0297", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1320.0, "discounted_cash": 79.0, "minimum": 63.888, "maximum": 1280.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 188.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 111.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 174.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 63.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 123.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 95.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 166.92, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.62, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 90.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 3", "code_information": [ { "code": "5313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9462.56, "maximum": 10030.3136, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9462.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10030.31, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9462.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9462.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9935.69, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Blood, L/R, Cmv-Neg Per Unit", "code_information": [ { "code": "P9051", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.3, "discounted_cash": 150.0, "minimum": 30.0, "maximum": 357.251, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 356.74, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 211.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 328.67, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 120.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 156.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 156.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.01, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 155.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 158.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 315.27, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.27, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Echo Heart,Transesophageal,Complete - 93312 - 48300003", "code_information": [ { "code": "93312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5181.94, "discounted_cash": 558.0, "minimum": 132.93, "maximum": 6482.51, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 614.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1321.14, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 782.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.93 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1217.16, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1448.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 865.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 670.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 575.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 586.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1167.56, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 878.7, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 631.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Breast Uni W Contrast", "code_information": [ { "code": "C8903", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2566.25, "discounted_cash": 179.0, "minimum": 109.31, "maximum": 2489.2625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1732.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1732.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1905.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - 80354 - 30100020", "code_information": [ { "code": "80354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.0, "minimum": 16.48, "maximum": 407.4, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.23 } ] } ] }, { "description": "Hc Neisseria Meningitidis", "code_information": [ { "code": "86741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.5, "discounted_cash": 13.0, "minimum": 9.1, "maximum": 174.115, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.55 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Compatibility Test, Electronic", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 809.42, "discounted_cash": 174.0, "minimum": 12.0, "maximum": 785.1374, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.92, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 53.52 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 364.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Debridemnt Wound, Non-Selective, Ea", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.77, "discounted_cash": 205.0, "minimum": 30.51, "maximum": 948.77, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 136.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 134.88 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Routine Footcare Pt W Lops", "code_information": [ { "code": "G0247", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 844.75, "discounted_cash": 205.0, "minimum": 125.04, "maximum": 819.4075, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay L/S Ratio", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 21.0, "minimum": 17.59, "maximum": 131.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 104.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 89.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.85, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Dist Fingr Fx Wo Manip Ea", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 48.0, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug/Substance Nos 1-3 - G0480 - 30100401", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.0, "discounted_cash": 114.0, "minimum": 10.185, "maximum": 890.46, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS - SOI : 1", "code_information": [ { "code": "8901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6334.47, "maximum": 6714.5382, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6334.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6714.54, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6334.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6334.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6651.19, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Pregnanetriol", "code_information": [ { "code": "84138", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.0, "discounted_cash": 21.0, "minimum": 16.84, "maximum": 258.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 23.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.57, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 74.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 63.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.84 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26108.0, "minimum": 17150.58, "maximum": 48485.33, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 23009.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 28719.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37009.55 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33940.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 32471.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21913.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48485.33 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17150.58 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 21913.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 35065.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 22790.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 27567.18, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 40468.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31330.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 21913.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26891.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 27413.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26108.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27446.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 26108.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 21913.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 27220.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21913.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26108.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chromosome Analy:Amniotic", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2341.0, "discounted_cash": 173.0, "minimum": 138.928, "maximum": 2270.77, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 260.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 359.46, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 809.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 692.84 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 243.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 178.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 208.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 259.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Contrast Inj,Abscess/Cyst Via Cath Tube", "code_information": [ { "code": "49424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.0, "minimum": 31.2, "maximum": 1069.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069.0 } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7960.99, "maximum": 8438.6494, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7960.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8438.65, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7960.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7960.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8359.04, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Radiologic Exam Abdomen 1 View", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.61, "discounted_cash": 88.0, "minimum": 13.77, "maximum": 417.6917, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 88.31 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay 17-(17-Ks)Ketosteroids", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.0, "discounted_cash": 12.0, "minimum": 10.24, "maximum": 234.74, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 54.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Intercostal, Mult, Regionl", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 904.0, "minimum": 43.5, "maximum": 3098.8105, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 949.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 994.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2138.52, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1265.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1356.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1970.2, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 940.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1401.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 931.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 949.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1889.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1422.36, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1021.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS - SOI : 4", "code_information": [ { "code": "4224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11234.14, "maximum": 11908.1884, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11234.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11908.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11234.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11234.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11795.85, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Semen Analysis, Sperm Presence And Motility", "code_information": [ { "code": "89321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.0, "discounted_cash": 12.0, "minimum": 8.3, "maximum": 132.89, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 49.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES- SOI : 1", "code_information": [ { "code": "1761", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14022.57, "maximum": 14863.9242, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14022.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 14863.92, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14022.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14022.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14723.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Immunodiffusion Ouchterlony", "code_information": [ { "code": "86331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 11.0, "minimum": 8.0, "maximum": 106.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.84 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis C Rna Dir Probe", "code_information": [ { "code": "87520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.0, "discounted_cash": 31.0, "minimum": 21.5, "maximum": 228.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 43.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.62, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 48.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.98 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 37.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Delivery/Birthing Room Resuscitation", "code_information": [ { "code": "99465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2077.0, "minimum": 361.1903, "maximum": 2014.69, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 423.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 423.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 423.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.91 } ] } ] }, { "description": "Hc Tobacco Cessation Asymptomatic >10 Min", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 38.0, "minimum": 19.3029, "maximum": 107.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.58, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.05, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.25, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 4", "code_information": [ { "code": "5304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17636.83, "maximum": 18695.0398, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17636.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18695.04, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17636.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17636.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18518.67, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Open Tx Articular Fracture Mcp/Ip Joint Ea", "code_information": [ { "code": "26746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4389.0, "discounted_cash": 3345.0, "minimum": 224.0, "maximum": 4389.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 380.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4389.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Injection For Shoulder X-Ray", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "minimum": 33.0, "maximum": 6637.71, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "OTHER BLADDER PROCEDURES - SOI : 3", "code_information": [ { "code": "4453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16565.41, "maximum": 17559.3346, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16565.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17559.33, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16565.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16565.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17393.68, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 2", "code_information": [ { "code": "7522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4093.96, "maximum": 4339.5976, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4093.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4339.6, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4093.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4093.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4298.66, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Prq Trluml Coronary Stent W/Angio One Art/Brnch - C9600 - 48100127", "code_information": [ { "code": "C9600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52136.0, "discounted_cash": 11801.0, "minimum": 1582.0, "maximum": 50571.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12982.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27912.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16522.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17702.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25715.23, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9441.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12274.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18292.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14162.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12155.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24667.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18564.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13336.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diffusing Capacity", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.06, "minimum": 33.12, "maximum": 642.1982, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 161.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.43 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES - SOI : 1", "code_information": [ { "code": "0981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7615.58, "maximum": 8072.5148, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7615.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8072.51, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7615.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7615.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7996.36, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "6312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30786.9, "maximum": 32634.114, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30786.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 32634.11, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 30786.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30786.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32326.25, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 2", "code_information": [ { "code": "2012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5123.01, "maximum": 5430.3906, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5123.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5430.39, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5123.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5123.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5379.16, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34378.18, "maximum": 36440.8708, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 34378.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 36440.87, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 34378.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34378.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36097.09, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES- SOI : 1", "code_information": [ { "code": "0291", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14643.74, "maximum": 15522.3644, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14643.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15522.36, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14643.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14643.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15375.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5734.84, "maximum": 6078.9304, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5734.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6078.93, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5734.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5734.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6021.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Insert Ventr Pm W Transvenous Electrode", "code_information": [ { "code": "33207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34713.0, "discounted_cash": 10685.0, "minimum": 488.9, "maximum": 33671.61, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11219.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11753.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25271.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14959.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16028.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23282.29, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8548.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11112.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16562.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12822.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11005.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 11219.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22333.63, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16808.25, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10685.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12074.43, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc C-Reactive Protein", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.75, "discounted_cash": 5.0, "minimum": 3.0, "maximum": 212.1875, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ileoscopy Thru Stoma Biopsy Sing/Mult", "code_information": [ { "code": "44382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890.0, "discounted_cash": 927.0, "minimum": 73.9, "maximum": 2890.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 344.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11707.0, "minimum": 6750.0, "maximum": 21942.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12878.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15918.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15219.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13966.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20853.91 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11618.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 15010.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10299.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.19, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18146.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14048.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9903.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12058.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 12292.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11707.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21942.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 11707.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9903.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11707.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11707.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28725 - ", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6263.58, "discounted_cash": 13125.0, "minimum": 776.0, "maximum": 6263.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6263.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3950.3, "discounted_cash": 801.0, "minimum": 488.55, "maximum": 5026.4818, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1895.37, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1121.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1746.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1448.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1242.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1675.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1260.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 905.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29898 - ", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2620.19, "discounted_cash": 3345.0, "minimum": 455.651, "maximum": 2620.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2620.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2620.19 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2620.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2620.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2620.19 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 932.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2620.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES- SOI : 1", "code_information": [ { "code": "3101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10264.69, "maximum": 10880.5714, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10264.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10880.57, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10264.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10264.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10777.92, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Right Ventricular Recording", "code_information": [ { "code": "93603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7805.0, "discounted_cash": 1244.0, "minimum": 995.776, "maximum": 7570.85, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1306.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1369.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2943.82, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1742.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1867.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2712.12, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 995.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1448.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1294.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1929.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1493.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1282.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1306.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2601.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1957.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1244.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1406.53, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thyroglobulin Antibody", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.63, "discounted_cash": 15.0, "minimum": 12.728, "maximum": 182.0011, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.93, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 66.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 57.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.09 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Organic Acids Qual Each", "code_information": [ { "code": "83919", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 397.7, "discounted_cash": 16.0, "minimum": 13.16, "maximum": 385.769, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.05, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.16 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trypsin Feces Qual", "code_information": [ { "code": "84488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 7.0, "minimum": 5.84, "maximum": 99.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 29.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Of Abdomen Contrast", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3382.99, "discounted_cash": 179.0, "minimum": 90.0, "maximum": 3281.5003, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 771.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 771.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 848.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endoven Ablt Incmptnt Vein Mchnchem Extr 1St Vein", "code_information": [ { "code": "36473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803.0, "discounted_cash": 3227.0, "minimum": 1582.0, "maximum": 11448.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fetal Bleed Screen, Rosette", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 9.0, "minimum": 7.488, "maximum": 139.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 25.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.23 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Doppler Fetal Umbilical Artery", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 106.0, "minimum": 21.53, "maximum": 765.4367, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 182.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 200.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE - SOI : 4", "code_information": [ { "code": "8504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49416.16, "maximum": 52381.1296, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 49416.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 52381.13, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 49416.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49416.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 51886.97, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "discounted_cash": 3309.0, "minimum": 776.0, "maximum": 6843.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3474.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3640.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6843.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4633.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4964.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6843.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2647.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5129.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3971.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3408.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3474.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6843.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5205.74, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3739.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CCMCC", "code_information": [ { "code": "760", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9933.0, "minimum": 4473.66, "maximum": 17450.42, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8845.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10926.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13320.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12913.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11687.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8423.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17450.42 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 4473.66 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8423.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 10934.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8760.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10597.15, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15397.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11920.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8423.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10231.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10430.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9933.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5396.4 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9933.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8423.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9796.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8423.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9933.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51432.0, "minimum": 10113.36, "maximum": 97074.59, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 45184.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 56575.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 74098.42 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 66861.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 65013.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 97074.59 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 45361.81 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 43033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 63706.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 44754.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 54135.89, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 79719.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 61718.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 43033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 52975.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 54003.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51432.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63806.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 51432.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 43033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 54499.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 51432.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10113.36 } ] } ] }, { "description": "Hc Ct Angio,Head Combo,Incl Image Process", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3616.88, "discounted_cash": 179.0, "minimum": 143.448, "maximum": 3508.3736, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 864.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 864.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 950.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WO INFARCT - SOI : 3", "code_information": [ { "code": "0463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10398.26, "maximum": 11022.1556, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10398.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11022.16, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10398.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10398.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10918.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 2", "code_information": [ { "code": "2822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6068.76, "maximum": 6432.8856, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6068.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6432.89, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6068.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6068.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6372.2, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES - SOI : 3", "code_information": [ { "code": "3513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8703.52, "maximum": 9225.7312, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8703.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.73, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8703.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8703.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9138.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT INFECTIONS - SOI : 1", "code_information": [ { "code": "4631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4151.41, "maximum": 4400.4946, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4151.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.49, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4151.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4151.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4358.98, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Detect Agent, Mult Orgs, Dna, Dir", "code_information": [ { "code": "87800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.63, "discounted_cash": 43.0, "minimum": 22.17, "maximum": 238.2611, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 48.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.39, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.94 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 52.4, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.4, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 43.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.35, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33073.0, "minimum": 14806.13, "maximum": 61849.84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 29108.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 36381.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47210.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42995.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 41422.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27722.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61849.84 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21950.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 27722.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 49396.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 28831.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 34874.91, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 51264.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 39688.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 27722.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 34065.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 34727.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33073.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33133.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 33073.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 27722.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 34723.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27722.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33073.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14806.13 } ] } ] }, { "description": "Partial amputation of toe", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6993.0, "discounted_cash": 3345.0, "minimum": 776.0, "maximum": 6993.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6993.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6993.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xylose Tolerance Test", "code_information": [ { "code": "84620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.0, "discounted_cash": 12.0, "minimum": 3.0, "maximum": 316.22, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 56.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 48.71 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruction Benign Lesions Up To 14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 471.25, "discounted_cash": 205.0, "minimum": 49.0, "maximum": 7307.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 471.25, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 471.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 471.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 471.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 471.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 471.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Infectious Agent Genotype Hepatitis B Virus", "code_information": [ { "code": "87912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.0, "discounted_cash": 257.0, "minimum": 187.5, "maximum": 606.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 283.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 360.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.1 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 532.9, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 468.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 468.32 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 400.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 399.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 205.96 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 308.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 265.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 308.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 319.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 290.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 1", "code_information": [ { "code": "0921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12702.68, "maximum": 13464.8408, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12702.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13464.84, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12702.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12702.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13337.81, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Enterovirus, Antibody", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.75, "discounted_cash": 13.0, "minimum": 9.0, "maximum": 186.9675, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Excision Of Pilonidal Cyst, Simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803.3, "discounted_cash": 2969.0, "minimum": 690.0, "maximum": 11449.201, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3266.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7023.14, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4157.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4454.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6470.37, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2375.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3088.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4602.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3563.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3058.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 690.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6206.73, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4671.18, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3355.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ambl Bld Press W/Tape/Disk 24/>Hr Alys W/Reprt", "code_information": [ { "code": "93788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1839.0, "discounted_cash": 136.0, "minimum": 82.92, "maximum": 1783.83, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Treat Elbow Dislocation", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6843.0, "discounted_cash": 1643.0, "minimum": 157.5, "maximum": 6637.71, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Speech Threshold Audiometry", "code_information": [ { "code": "92555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 60.0, "minimum": 6.5, "maximum": 147.9735, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 66.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 131.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 93.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 126.03, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.85, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14996.0, "minimum": 9534.49, "maximum": 27165.5, "payers_information": [ { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15446.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 15746.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14037.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12646.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15251.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12646.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14996.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13278.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16496.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20735.82 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19496.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18193.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12646.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27165.5 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9534.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12646.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18191.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13152.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15909.42, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23245.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17996.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 12646.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Sho arthrs srg rt8tr cuf rpr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4028.95, "discounted_cash": 7418.0, "minimum": 700.6344, "maximum": 4028.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4028.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4028.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4028.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fetal Lung Maturity Lamellar Body Density", "code_information": [ { "code": "83664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 19.0, "minimum": 5.22, "maximum": 131.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perc Lamino-/Laminectomy Indir Imag Guide Lumbar", "code_information": [ { "code": "0275T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 7148.0, "minimum": 1582.0, "maximum": 25324.566, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7505.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7863.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16906.26, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10007.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10722.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15575.63, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5718.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7434.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11080.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8578.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7362.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7505.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14940.99, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11244.56, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7148.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8077.68, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ex For Speech Device Rx Ea Add 30 Min", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 49.0, "minimum": 13.3903, "maximum": 77.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 68.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 73.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.0, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 76.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 59.02, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.02, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 49.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK - SOI : 1", "code_information": [ { "code": "1701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17519.06, "maximum": 18570.2036, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17519.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18570.2, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17519.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17519.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18395.01, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9516.0, "minimum": 6049.54, "maximum": 16650.22, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8479.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10468.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12709.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12371.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11151.08 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8076.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16650.22 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6049.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8076.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11287.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8399.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10159.61, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14750.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11419.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8076.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9802.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 9992.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9516.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8076.64 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9516.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8076.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9347.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8076.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9516.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelogram Inj; Spinal Not C1-C2", "code_information": [ { "code": "62284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4596.0, "minimum": 79.54, "maximum": 4458.12, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 596.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "OTHER MAJOR HEAD & NECK PROCEDURES - SOI : 2", "code_information": [ { "code": "0912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22448.9, "maximum": 23795.834, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22448.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 23795.83, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 22448.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22448.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23571.35, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT <1500G W MAJOR PROCEDURE - SOI : 4", "code_information": [ { "code": "5884", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 271360.16, "maximum": 287641.7696, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 271360.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 287641.77, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 271360.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 271360.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 284928.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11396.0, "minimum": 8586.9927, "maximum": 20258.08, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10126.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 12536.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15463.28 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14816.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 13567.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9644.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20258.08 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12779.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9644.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14456.83 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10029.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 12132.39, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17665.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13676.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9644.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11738.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 11966.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11396.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13184.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 11396.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9644.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 11373.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9644.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11396.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bilirubin Total", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.41, "discounted_cash": 5.0, "minimum": 4.016, "maximum": 92.5477, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "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": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Lumbar Spine 2/3 Vw", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 645.19, "discounted_cash": 106.0, "minimum": 22.5, "maximum": 625.8343, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 90.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 99.02 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 352.18, "10th_percentile": 193.56, "90th_percentile": 589.41, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pneumocystis Carinii Ag, Immunofluor", "code_information": [ { "code": "87281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.0, "discounted_cash": 11.0, "minimum": 9.58, "maximum": 499.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "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": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Revasc Tibial/Peron Art Angiopl/Stnt/Atherc Ini", "code_information": [ { "code": "37231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25685.0, "discounted_cash": 17968.0, "minimum": 675.5, "maximum": 25685.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18866.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19765.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25685.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25155.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25685.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25685.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14374.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 675.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18687.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25685.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21562.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18507.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18866.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25685.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25685.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 720.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17968.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20304.33, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sigmoidoscopy Flex Blln Dilat", "code_information": [ { "code": "45340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 1223.0, "minimum": 105.4, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45499.0, "minimum": 28800.0, "maximum": 85691.54, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 49874.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 38085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 79707.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 39608.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 47911.56, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 70524.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 54599.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 38085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 46864.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 47774.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45499.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68264.3 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 45499.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 38085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 48108.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45499.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 39989.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 50049.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 65409.58 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 59149.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 57389.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 85691.54 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9534.0, "minimum": 7072.3752, "maximum": 22377.11, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8495.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10488.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12735.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12395.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11174.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8091.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16684.86 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8217.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8091.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11949.18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8414.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10178.54, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14778.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11441.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8091.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9820.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10011.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9534.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9704.65 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9534.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8091.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9367.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8091.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9534.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22377.11 } ] } ] }, { "description": "VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &OR D&C - SOI : 4", "code_information": [ { "code": "5424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19819.17, "maximum": 21008.3202, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19819.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21008.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19819.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19819.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20810.13, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 20.0, "minimum": 8.0, "maximum": 276.45, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.89, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 98.49 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 84.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.19 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32023.0, "minimum": 16759.43, "maximum": 59835.47, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 28189.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 35226.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45673.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 41631.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 40073.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26846.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59835.47 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24857.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 26846.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 38261.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 27920.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 33773.4, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 49637.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38428.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 26846.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 32984.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 33625.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32023.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47192.1 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 32023.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 26846.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 33592.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26846.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32023.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16759.43 } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 1", "code_information": [ { "code": "5401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4632.54, "maximum": 4910.4924, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4910.49, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4632.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4864.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Chromosome Anal:15-20,2 Karyotypes", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1129.59, "discounted_cash": 125.0, "minimum": 100.39, "maximum": 1095.7023, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 125.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 175.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 188.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 259.75, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 603.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 603.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 516.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 194.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 100.39 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 150.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 141.8, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Mrsplzatn Brthlns Glnd Cst", "code_information": [ { "code": "56440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7629.67, "discounted_cash": 3309.0, "minimum": 748.0, "maximum": 7629.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3474.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3640.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7629.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4633.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4964.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7210.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2647.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5129.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3971.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3408.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3474.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 748.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6917.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5205.74, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3309.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3739.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING - SOI : 3", "code_information": [ { "code": "2493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7715.4, "maximum": 8178.324, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7715.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8178.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7715.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7715.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8101.17, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MASTECTOMY PROCEDURES - SOI : 4", "code_information": [ { "code": "3624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24651.35, "maximum": 26130.431, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24651.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 26130.43, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24651.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24651.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25883.92, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS - SOI : 3", "code_information": [ { "code": "4253", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7558.13, "maximum": 8011.6178, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7558.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8011.62, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7558.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7558.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7936.04, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 3", "code_information": [ { "code": "9513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20245.01, "maximum": 21459.7106, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20245.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21459.71, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 20245.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20245.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21257.26, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16844.0, "minimum": 6980.8, "maximum": 30711.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14897.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 18529.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23442.16 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21898.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20567.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30711.01 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9524.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21387.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14755.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 17848.13, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26109.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20213.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14187.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17350.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 17687.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16849.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 16844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14187.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17241.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16844.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6980.8 } ] } ] }, { "description": "Hc Inj, Therap/Proph/Diagn, Iv Push Init Dx", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1015.78, "discounted_cash": 217.0, "minimum": 31.02, "maximum": 985.3066, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 239.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 514.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 304.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 473.8, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.04, "median_amount": 322.22, "10th_percentile": 322.22, "90th_percentile": 322.22, "count": "1 through 10" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "percent of total billed charges", "standard_charge_percentage": 53.66, "median_amount": 192.51, "10th_percentile": 192.51, "90th_percentile": 192.51, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 337.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 260.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 228.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 454.5, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 342.05, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 217.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 245.72, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trim Benign Hyperkeratotic Skin Lesion,>4", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 623.45, "discounted_cash": 205.0, "minimum": 108.418, "maximum": 623.45, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 623.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remv Perm Pacer Generator", "code_information": [ { "code": "33233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25035.3, "discounted_cash": 8460.0, "minimum": 1582.0, "maximum": 24284.241, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8883.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9306.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20008.6, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11844.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12690.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18433.8, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6768.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8798.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13113.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10152.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8713.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 8883.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17682.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13307.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8460.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9559.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.94, "discounted_cash": 8.0, "minimum": 5.0, "maximum": 209.4618, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.12, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunoassay, Tumor Antigen, Quant", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.7, "discounted_cash": 20.0, "minimum": 16.648, "maximum": 239.299, "payers_information": [ { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 87.24 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.5 } ] } ] }, { "description": "Hc Duplex Large Vessel(S),Complete", "code_information": [ { "code": "93978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4437.0, "discounted_cash": 243.0, "minimum": 90.63, "maximum": 4303.89, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.63 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1170.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1170.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1158.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Sesamoid Fx", "code_information": [ { "code": "28530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 252.0, "minimum": 89.45, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Multiple Sleep Latency Test", "code_information": [ { "code": "95805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5728.19, "discounted_cash": 877.0, "minimum": 201.32, "maximum": 5556.3443, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 921.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 965.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2076.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1229.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1316.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1912.88, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1573.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1573.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1393.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1360.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1053.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 904.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 921.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1834.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1380.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 992.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7743.0, "discounted_cash": 6618.0, "minimum": 776.0, "maximum": 7743.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6949.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7280.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5294.68, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6883.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6816.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6949.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7743.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6618.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7478.74, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oxycodone Screening - 80365 - 30100024", "code_information": [ { "code": "80365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "minimum": 22.05, "maximum": 388.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.5 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.8 } ] } ] }, { "description": "Hc Detect Agent Nos, Dna, Amp", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1960.0, "discounted_cash": 35.0, "minimum": 23.19, "maximum": 1901.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.19 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 72.63, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 129.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Fth grf fr neel 20 sqcm<", "code_information": [ { "code": "15260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8769.25, "discounted_cash": 2109.0, "minimum": 776.0, "maximum": 8506.1725, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2320.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4988.68, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2953.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3164.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4596.04, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1687.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2193.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3269.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2172.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2214.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4408.77, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3318.03, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2383.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ORBITAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22062.0, "minimum": 15177.82, "maximum": 40722.27, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 19466.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 24268.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31083.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28681.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 27272.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18539.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40722.27 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15177.82 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 18539.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 28186.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 19280.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 23322.31, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 34196.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26474.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 18539.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22724.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 23165.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22062.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16590.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 22062.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 18539.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 22862.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18539.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22062.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30571.29 } ] } ] }, { "description": "Hc Tone Decay Hearing Test", "code_information": [ { "code": "92563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 38.0, "minimum": 14.21, "maximum": 147.9735, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 38.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 79.8, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS - SOI : 1", "code_information": [ { "code": "3811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3813.89, "maximum": 4042.7234, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3813.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4042.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3813.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3813.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4004.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remove Int Dwell Ureteral Stent Transurethral", "code_information": [ { "code": "50386", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11512.6, "discounted_cash": 2137.0, "minimum": 776.0, "maximum": 11167.222, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2350.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5054.22, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2991.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3205.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4656.42, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1709.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1094.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1094.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1094.76 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2222.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3312.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2201.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2243.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4466.69, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3361.62, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2414.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endomyocardial Biopsy", "code_information": [ { "code": "93505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803.0, "discounted_cash": 3227.0, "minimum": 198.8, "maximum": 11448.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 899.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Heparin Neutralization", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11.0, "minimum": 9.47, "maximum": 134.7621, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Resect inferior turbinate", "code_information": [ { "code": "30140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7902.0, "discounted_cash": 3389.0, "minimum": 776.0, "maximum": 7902.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3728.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7902.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4745.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5084.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7385.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2711.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3525.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5253.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4067.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3491.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7084.42, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5331.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3830.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pms2 Gene Analysis Full Sequence", "code_information": [ { "code": "81317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500.0, "discounted_cash": 676.0, "minimum": 450.0, "maximum": 1455.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 710.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 744.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 947.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1014.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.03 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1400.29, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 541.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1328.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1328.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1137.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1048.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 541.2 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 811.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 696.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 710.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 811.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 811.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 764.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Toe Fx W Manip Ea", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1117.58, "discounted_cash": 252.0, "minimum": 66.5, "maximum": 1117.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1117.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Treat foot bone lesion", "code_information": [ { "code": "28005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1748.25, "discounted_cash": 3345.0, "minimum": 304.0207, "maximum": 1748.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1748.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1748.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1748.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1748.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1748.25 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 860.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1748.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1748.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "817", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21435.0, "minimum": 9494.87, "maximum": 39518.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 18916.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 23578.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30165.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27865.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 26466.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18015.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39518.5 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9494.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 18015.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 30947.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 18736.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 22664.0, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33224.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25722.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 18015.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 22078.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 22506.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21435.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14910.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 21435.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 18015.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 22186.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18015.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21435.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Stent Ather S - 92933 - 48100194", "code_information": [ { "code": "92933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73910.7, "discounted_cash": 18740.0, "minimum": 1582.0, "maximum": 71693.379, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19677.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20615.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44323.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26237.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28111.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40834.57, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14992.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19490.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29048.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22489.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19303.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 19677.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 39170.73, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29479.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21177.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10838.0, "minimum": 7384.9, "maximum": 19185.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9637.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11921.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14644.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14089.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 12849.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9178.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19185.94 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7413.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 9178.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14779.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 9545.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 11546.14, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16799.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13005.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 9178.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 11163.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 11380.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10838.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9539.85 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10838.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 9178.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10771.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9178.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10838.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7384.9 } ] } ] }, { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE - SOI : 2", "code_information": [ { "code": "2522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6791.19, "maximum": 7198.6614, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6791.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.66, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6791.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6791.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7130.75, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 4", "code_information": [ { "code": "3414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15404.22, "maximum": 16328.4732, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15404.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16328.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15404.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15404.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16174.43, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fees W/Laryngeal Sense Test", "code_information": [ { "code": "92616", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 725.0, "discounted_cash": 82.0, "minimum": 65.64, "maximum": 725.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 169.84, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 725.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 725.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 725.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 127.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 98.46, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.46, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 92.72, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7020.98, "maximum": 7442.2388, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7442.24, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7372.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Russell Viper Venom, Diluted", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.4, "discounted_cash": 9.0, "minimum": 7.66, "maximum": 170.138, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 41.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 35.59 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.66 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.83, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ed Level 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3043.97, "discounted_cash": 608.0, "minimum": 138.74, "maximum": 2952.6509, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 639.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 669.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1439.89, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 852.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 913.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 334.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1326.56, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 487.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 886.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 886.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 666.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 913.19, "10th_percentile": 913.15, "90th_percentile": 913.22, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 387.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 943.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 17.39, "median_amount": 529.35, "10th_percentile": 529.35, "90th_percentile": 529.35, "count": "1 through 10" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 730.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 380.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 627.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 639.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1272.51, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 957.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 608.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 687.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [ { "code": "809", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12266.0, "minimum": 8349.27, "maximum": 21926.05, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 10887.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 13492.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16736.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 15946.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 14684.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10369.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21926.05 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8349.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10369.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 14946.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 10783.97, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 13044.45, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19012.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14719.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10369.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 12634.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 12879.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12266.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10986.1 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 12266.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10369.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12309.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10369.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12266.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 22.0, "minimum": 18.38, "maximum": 276.45, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.19 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.57, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 93.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.58 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.2 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drainage Of Palmar Bursa Single Bursa", "code_information": [ { "code": "26025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6749.7, "discounted_cash": 3345.0, "minimum": 776.0, "maximum": 6749.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17189.0, "minimum": 10077.02, "maximum": 33557.87, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15199.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 18908.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23947.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22346.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21011.08 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14475.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31372.66 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 33557.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14475.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 20924.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15054.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18209.93, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26643.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20627.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14475.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17705.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18049.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17189.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16562.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17189.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14475.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17613.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14475.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17189.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10077.02 } ] } ] }, { "description": "Hc X-Ray Salivary Gland", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 88.0, "minimum": 21.0, "maximum": 765.4367, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 85.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 93.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7335.0, "minimum": 4984.71, "maximum": 12465.58, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 6569.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8069.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9515.15 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 9536.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 8348.52 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12465.58 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 4984.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9179.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 6507.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 7871.43, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11370.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8802.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 7555.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 7702.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7244.16 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 7335.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6998.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7335.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6609.74 } ] } ] }, { "description": "Hc Body Fluid Cell Count W Diff", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.78, "discounted_cash": 5.0, "minimum": 4.48, "maximum": 168.5666, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 23.01 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.48 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Estradiol", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.25, "discounted_cash": 27.0, "minimum": 21.5, "maximum": 277.6625, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.94 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 115.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.35 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "Optx Dst Rd Xart Fx/Epi Sep2", "code_information": [ { "code": "25608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11493.0, "discounted_cash": 7418.0, "minimum": 776.0, "maximum": 11493.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8160.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11493.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10385.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11127.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11493.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11493.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8901.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11493.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11493.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8382.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LUNG TRANSPLANT", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 117741.0, "minimum": 27532.33, "maximum": 224304.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 103251.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 129516.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 171214.59 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 153064.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 150222.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 98334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 224304.2 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 105749.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 98334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 128833.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 102268.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 123705.3, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 182499.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 141290.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 98334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 121274.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 123628.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 117741.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 125469.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 117741.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 98334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 125927.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 98334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 117741.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27532.33 } ] } ] }, { "description": "Hc Venogram Hepatic", "code_information": [ { "code": "75891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6504.0, "discounted_cash": 3227.0, "minimum": 121.5, "maximum": 6504.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6504.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6504.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6504.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hemoglobin Electrophoresis", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.0, "discounted_cash": 12.0, "minimum": 10.296, "maximum": 234.74, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 44.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 2", "code_information": [ { "code": "3642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8908.9, "maximum": 9443.434, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8908.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9443.43, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8908.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8908.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9354.35, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remv F.B.,Eye,Cornea,No Slit", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1888.22, "discounted_cash": 456.0, "minimum": 328.3615, "maximum": 1888.22, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 479.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 502.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1080.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 639.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 685.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 995.08, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 365.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1888.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 474.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 707.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 548.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 470.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 479.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 772.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 954.54, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 718.38, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1888.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 516.06, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49876.0, "minimum": 6821.15, "maximum": 94090.26, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 43822.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 54864.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71820.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 64839.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 63014.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41736.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 94090.26 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 53252.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 41736.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 53243.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 43405.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 52504.01, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 77309.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 59852.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 41736.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 51373.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 52370.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49876.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70780.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 49876.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 41736.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 52823.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41736.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 49876.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6821.15 } ] } ] }, { "description": "Hc Insert,Temp Indwelling Blad Cath,Comp", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 582.63, "discounted_cash": 131.0, "minimum": 101.3194, "maximum": 582.63, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 144.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 311.1, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 184.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 197.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 582.63 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.61, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 582.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 203.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 582.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 274.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.92, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 582.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Sinuses <3 Vw", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.06, "discounted_cash": 88.0, "minimum": 16.5, "maximum": 462.7482, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 77.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 85.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38767.0, "minimum": 28972.38, "maximum": 72773.9, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 34094.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 42643.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55549.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50397.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 48738.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72773.9 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28972.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 43552.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 33769.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 40848.14, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 60089.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46520.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 32470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 39930.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 40705.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38767.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31375.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 38767.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 40856.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32470.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38767.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent >30.1 Cm", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2109.0, "minimum": 776.0, "maximum": 6924.6845, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2214.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2320.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4988.68, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2953.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3164.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4596.04, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1687.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2193.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3269.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2172.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2214.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4408.77, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3318.03, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2109.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2383.55, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.5, "discounted_cash": 14.0, "minimum": 10.3, "maximum": 201.275, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.84, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 50.34 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Elect Stimul Unattnd For Ulcers - G0281 - 42000026", "code_information": [ { "code": "G0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 12.0, "minimum": 9.664, "maximum": 237.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor Xii Test", "code_information": [ { "code": "85280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 664.88, "discounted_cash": 19.0, "minimum": 13.0, "maximum": 644.9336, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.05, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 70.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.48 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.22 }, { "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": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS - SOI : 1", "code_information": [ { "code": "1301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22473.32, "maximum": 23821.7192, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22473.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 23821.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 22473.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22473.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23596.99, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Repair hand joint with graft", "code_information": [ { "code": "26541", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9603.0, "discounted_cash": 3345.0, "minimum": 776.0, "maximum": 9314.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7911.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5505.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 5505.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 4362.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis B Surface Ag, Eia", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.25, "discounted_cash": 10.0, "minimum": 8.26, "maximum": 151.5625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 44.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 38.27 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.01 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES - SOI : 2", "code_information": [ { "code": "5182", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12301.26, "maximum": 13039.3356, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12301.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13039.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12301.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12301.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12916.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Legion Pneumo Dna, Amp Prob", "code_information": [ { "code": "87541", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.0, "discounted_cash": 35.0, "minimum": 24.2, "maximum": 290.03, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 72.63, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 151.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 129.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Malig 2.1-3 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 5997.607, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Lower Extrem W/Contrast", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4332.5, "discounted_cash": 356.0, "minimum": 285.32, "maximum": 4202.525, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 326.22 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thrombolysis Arterial Infusion W/Img Init Tx", "code_information": [ { "code": "37211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19621.4, "discounted_cash": 5688.0, "minimum": 343.3, "maximum": 19032.758, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5973.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6257.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13454.07, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7964.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8533.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12395.15, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4550.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5916.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8817.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6826.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5859.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5973.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11890.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8948.47, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6428.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Transcath Stent Cca W/O Eps", "code_information": [ { "code": "37216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "minimum": 173.9, "maximum": 1000.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1000.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1000.0 } ] } ] }, { "description": "Hc Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5728.19, "discounted_cash": 877.0, "minimum": 517.67, "maximum": 5556.3443, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 921.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 965.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2076.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1229.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1316.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 517.67 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1912.88, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1573.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1573.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1393.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 548.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1360.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1053.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 904.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 921.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 517.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1834.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1380.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 877.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 992.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Gfrg autol fat lipo ea addl", "code_information": [ { "code": "15774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2059.12, "minimum": 358.081, "maximum": 2059.12, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2059.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2059.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2059.12 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2059.12 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2059.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Inj Dx/Ther Sbst Intrlmnr Crv/Thrc Wo Img", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1969.34, "discounted_cash": 721.0, "minimum": 342.4682, "maximum": 1969.34, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 757.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 793.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1706.71, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1010.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1082.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1572.38, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 577.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1969.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 750.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1118.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 865.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 743.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 757.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1508.31, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1135.15, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1969.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 721.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 815.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Natriuretic Peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.81, "discounted_cash": 39.0, "minimum": 31.408, "maximum": 318.9457, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 43.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.94 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.26, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 60.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.41 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 47.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.36, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hpv High-Risk Types", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.0, "discounted_cash": 35.0, "minimum": 28.07, "maximum": 582.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 72.63, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "627", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12829.0, "minimum": 5850.0, "maximum": 23006.85, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14112.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17561.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16678.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15408.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10839.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23006.85 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12125.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10839.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13505.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11272.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 13635.46, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19885.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15395.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10839.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13214.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 13471.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12829.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15519.4 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 12829.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10839.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12916.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10839.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12829.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRANSIENT ISCHEMIA - SOI : 2", "code_information": [ { "code": "0472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6813.45, "maximum": 7222.257, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6813.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7222.26, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6813.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6813.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7154.12, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE - SOI : 2", "code_information": [ { "code": "0552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8288.45, "maximum": 8785.757, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8288.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8785.76, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8288.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8288.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8702.87, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3901.5, "maximum": 4135.59, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3901.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4135.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3901.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3901.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4096.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.0, "discounted_cash": 29.0, "minimum": 23.42, "maximum": 271.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.61, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 144.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 123.37 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.42 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.14 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.25 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Calr Gene Analysis Common Variants In Exon 9", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 623.0, "discounted_cash": 121.0, "minimum": 83.8, "maximum": 604.31, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 133.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 182.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 251.76, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 189.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 97.3 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 145.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51148.96, "maximum": 54217.8976, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 51148.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 54217.9, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 51148.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 51148.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 53706.41, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Bone Imaging, Multiple Areas", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.0, "discounted_cash": 408.0, "minimum": 44.1706, "maximum": 254.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 254.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 254.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Slctv Cath Xtrnl Carotid Angio Xtrnl Carotd Cir", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3850.0, "minimum": 92.1, "maximum": 3734.5, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.1 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41296.0, "minimum": 8010.31, "maximum": 77627.11, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 36309.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 45426.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59253.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 53685.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 51988.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 77627.11 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29039.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 34580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 59731.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 35963.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 43501.89, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 64009.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49555.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 34580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 42535.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 43361.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41296.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42168.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 41296.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 34580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 43581.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41296.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8010.31 } ] } ] }, { "description": "Hc Nm Bowel Imaging", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1824.5, "discounted_cash": 408.0, "minimum": 45.0, "maximum": 1769.765, "payers_information": [ { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 357.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 393.39 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ephys Eval W Ablation Supravent Arrhythmia", "code_information": [ { "code": "93653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25300.0, "discounted_cash": 26721.0, "minimum": 1582.0, "maximum": 25300.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21377.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25300.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mastotomy W Explor/Drain Absc, Deep", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9373.31, "discounted_cash": 1688.0, "minimum": 821.0, "maximum": 9092.1107, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 821.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flexible Transoral Diagnostic", "code_information": [ { "code": "43200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890.0, "discounted_cash": 927.0, "minimum": 99.1, "maximum": 2890.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2890.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 885.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Maxillofacial Area Combo", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3391.25, "discounted_cash": 179.0, "minimum": 100.0, "maximum": 3289.5125, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 812.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 812.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 893.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Occup Therapy Evaluation, 15 Min", "code_information": [ { "code": "97003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.75, "minimum": 18.675, "maximum": 1086.885, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0 } ] } ] }, { "description": "LIVER TRANSPLANT &OR INTESTINAL TRANSPLANT - SOI : 4", "code_information": [ { "code": "0014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 141108.29, "maximum": 149574.7874, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 141108.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 149574.79, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 141108.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 141108.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 148163.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Angio,Neck Combo,Incl Image Process", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3631.05, "discounted_cash": 179.0, "minimum": 143.448, "maximum": 3522.1185, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 864.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 864.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 950.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 212.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 200.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Single Transven Electrod/Pm/Defib", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12798.0, "discounted_cash": 3820.0, "minimum": 386.3, "maximum": 12414.06, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4011.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4202.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9035.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5348.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5730.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8324.25, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3056.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 386.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3973.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5921.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4584.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3935.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4011.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7985.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6009.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3820.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4317.04, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS - SOI : 2", "code_information": [ { "code": "8932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8304.25, "maximum": 8802.505, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8304.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8802.51, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8304.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8304.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8719.46, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of G6Pd Enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.0, "discounted_cash": 9.0, "minimum": 7.76, "maximum": 129.98, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chylmd Trach Ag, Dfa", "code_information": [ { "code": "87270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.0, "discounted_cash": 11.0, "minimum": 8.3, "maximum": 150.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.3 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flex Us Fna/Fnb", "code_information": [ { "code": "43232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1961.0, "minimum": 621.7412, "maximum": 3575.28, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 723.0, "minimum": 454.38, "maximum": 2695.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hospital Outpt Clinic Visit Lvl Iv", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.45, "discounted_cash": 136.0, "minimum": 70.1478, "maximum": 1211.6561, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.47, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.09, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.79, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.88, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.55, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.96, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17712.0, "minimum": 13723.3299, "maximum": 32375.52, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15656.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19483.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24712.69 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23025.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21682.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14911.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32375.52 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17101.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14911.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21275.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15507.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18758.29, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27454.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14911.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18243.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18597.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17712.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20108.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17712.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14911.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 18176.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14911.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17712.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 16.0, "minimum": 11.6, "maximum": 200.3535, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 62.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tissue Transglutaminase Ea Immunoglobulin Class", "code_information": [ { "code": "86364", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.34, "discounted_cash": 11.0, "minimum": 7.9, "maximum": 53.6798, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES - SOI : 4", "code_information": [ { "code": "1814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37530.69, "maximum": 39782.5314, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 37530.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 39782.53, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 37530.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37530.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 39407.22, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Pelvis 1/2 Vw", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 528.75, "discounted_cash": 106.0, "minimum": 10.0, "maximum": 512.8875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 72.25 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 660.12, "10th_percentile": 660.12, "90th_percentile": 693.19, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [ { "code": "884", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15362.0, "minimum": 6196.2, "maximum": 27866.98, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13599.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16898.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21271.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19971.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 18663.24 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27866.98 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13709.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16675.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 16292.99, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23811.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18435.05, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 12951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15823.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 16130.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15362.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13732.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 15362.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15644.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12951.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15362.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Angio, Chest, Combo, Incl Image Proc", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4846.81, "discounted_cash": 179.0, "minimum": 143.448, "maximum": 4701.4057, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 197.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 424.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 390.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 963.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1059.74 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1454.05, "10th_percentile": 1454.05, "90th_percentile": 1454.05, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 277.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 374.78, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 179.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 202.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER COMPLICATIONS OF TREATMENT - SOI : 1", "code_information": [ { "code": "8131", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4868.08, "maximum": 5160.1648, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4868.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5160.16, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4868.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4868.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5111.48, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Us, Head, Real Time", "code_information": [ { "code": "76506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1958.0, "discounted_cash": 106.0, "minimum": 47.5, "maximum": 1899.26, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 227.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3986.24, "maximum": 4225.4144, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3986.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4225.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3986.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3986.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4185.55, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NON-EXTENSIVE BURNS", "code_information": [ { "code": "935", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19434.0, "minimum": 11466.8, "maximum": 35680.27, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 17164.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 21378.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27235.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 25265.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 23896.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35680.27 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12563.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 16347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22387.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 17001.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 20565.28, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30123.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23321.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 16347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 20017.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 20406.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11466.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 19434.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 16347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 20031.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19434.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remove Full Arm/Leg Cast", "code_information": [ { "code": "29705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.0, "discounted_cash": 285.0, "minimum": 36.3451, "maximum": 209.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 209.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nasal Endo Sx,Dacryocystorhinostomy", "code_information": [ { "code": "31239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12156.2, "discounted_cash": 3811.0, "minimum": 776.0, "maximum": 11791.514, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4002.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4192.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9014.55, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5336.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5717.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8305.05, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3964.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5907.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4573.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3925.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4002.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7966.66, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5995.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4307.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 1", "code_information": [ { "code": "0401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8629.55, "maximum": 9147.323, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8629.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9147.32, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8629.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8629.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9061.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 7.6-12.5 Cm", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 755.0, "minimum": 310.7489, "maximum": 1786.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 793.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 831.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1786.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1057.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1133.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1646.31, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 785.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1171.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 906.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 778.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 793.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 738.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1579.23, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1188.53, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 755.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 853.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18992.0, "minimum": 12573.15, "maximum": 34831.57, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16777.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 20891.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26587.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24690.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 23327.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34831.57 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17285.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 22959.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 20101.2, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29438.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22790.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 15978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19562.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 19941.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18992.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22682.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 18992.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 19554.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18992.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12573.15 } ] } ] }, { "description": "REHABILITATION - SOI : 1", "code_information": [ { "code": "8601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9075.5, "maximum": 9620.03, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9075.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9620.03, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9075.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9075.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9529.28, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES - SOI : 2", "code_information": [ { "code": "3472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7360.65, "maximum": 7802.289, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7360.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7802.29, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7360.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7360.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7728.68, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Perq Dilation Xst Trc Endourologic Px W/Img", "code_information": [ { "code": "50436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8698.75, "discounted_cash": 3603.0, "minimum": 776.0, "maximum": 8522.8618, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3783.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3964.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8522.86, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5045.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5405.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7852.06, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2882.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3747.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5585.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4324.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3711.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3783.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7532.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5668.66, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3603.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4072.16, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1196.25, "minimum": 208.0279, "maximum": 1196.25, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1196.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1196.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1196.25 } ] } ] }, { "description": "Hc Myelography Thorax Spine", "code_information": [ { "code": "72255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3606.88, "discounted_cash": 801.0, "minimum": 36.75, "maximum": 3498.6736, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1895.37, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1121.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1746.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.96 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1242.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1675.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1260.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 905.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urinalysis", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7.0, "discounted_cash": 2.0, "minimum": 1.736, "maximum": 7.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 1.74 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Corrj halux rigdus wimplt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3206.0, "discounted_cash": 7418.0, "minimum": 557.5234, "maximum": 3206.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3206.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3206.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3206.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3206.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3206.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3206.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16247.0, "minimum": 8135.81, "maximum": 29564.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14373.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17871.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22566.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21121.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19800.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13689.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29564.4 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12739.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13689.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21039.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14236.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 17221.14, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25183.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19496.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 13689.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16734.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 17059.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16247.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8135.81 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 16247.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13689.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16597.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13689.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16247.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11080.1 } ] } ] }, { "description": "Hc Drainage Of Mouth Lesion, Complicated", "code_information": [ { "code": "40801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2213.1, "discounted_cash": 551.0, "minimum": 384.8581, "maximum": 2213.1, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 578.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 606.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1304.01, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 771.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 827.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1201.38, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 441.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 573.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 854.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 661.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 567.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 578.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1152.43, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 867.32, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 551.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 623.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITH CCMCC", "code_information": [ { "code": "904", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33996.0, "minimum": 26967.239, "maximum": 70013.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 29916.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 37395.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48562.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 44195.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 42607.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28491.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63620.0 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 27210.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 28491.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 39317.51 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 29631.58, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 35842.81, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 52694.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40795.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 28491.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 35016.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 35696.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70013.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 33996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 28491.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35717.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28491.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33996.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Tunnel Intraperitoneal Cath W Img Guide", "code_information": [ { "code": "49418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9056.68, "discounted_cash": 3660.0, "minimum": 776.0, "maximum": 8784.9796, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4026.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8656.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5124.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5490.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7975.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2928.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3806.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5673.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4392.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3770.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7650.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5757.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4136.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 750-999G WO MAJOR PROCEDURE - SOI : 4", "code_information": [ { "code": "5934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 156447.88, "maximum": 165834.7528, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 156447.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 165834.75, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 156447.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 156447.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 164270.27, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66849.05, "maximum": 70859.993, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 66849.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 70859.99, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 66849.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 66849.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 70191.5, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41882.0, "minimum": 6072.42, "maximum": 78751.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 36822.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 46070.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60111.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 54447.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 52741.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78751.21 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 35614.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 35068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 51994.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 36471.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 44116.55, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 64917.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 50258.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 35068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43138.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 43976.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41882.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45136.3 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 41882.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 35068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44212.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41882.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6072.42 } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.0, "discounted_cash": 12.0, "minimum": 10.36, "maximum": 63.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.9 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 63.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 63.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tracheotomy Planned", "code_information": [ { "code": "31600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3389.0, "minimum": 1582.0, "maximum": 10542.445, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3728.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8016.27, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4745.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5084.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7385.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2711.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3525.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5253.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4067.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3491.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7084.42, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5331.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3830.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diagnostic Anoscopy", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1329.0, "discounted_cash": 136.0, "minimum": 21.2, "maximum": 1329.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1329.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 1329.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1329.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established High Mdm 40-54 Min - G0463 - 76100010", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 912.94, "discounted_cash": 136.0, "minimum": 70.1478, "maximum": 1211.6561, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.88, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.55, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.04, "median_amount": 341.99, "10th_percentile": 341.99, "90th_percentile": 341.99, "count": "1 through 10" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.47, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 214.09, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.79, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Inc&Rmvl Fb Subq Tiss Comp", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8223.0, "discounted_cash": 1688.0, "minimum": 686.2529, "maximum": 7976.31, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 720.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drainage Scrotal Wall Abscess", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6213.44, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 6027.0368, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert/Place Flow Direct Cath", "code_information": [ { "code": "93503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7589.86, "discounted_cash": 1609.0, "minimum": 1287.44, "maximum": 7362.1642, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1770.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3806.07, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2253.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2413.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3506.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1287.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1673.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2494.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1931.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1657.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1689.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3363.63, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.46, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1818.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3121", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12307.72, "maximum": 13046.1832, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12307.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13046.18, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12307.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12307.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12923.11, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CCMCC", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12980.0, "minimum": 9000.0, "maximum": 23296.1, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13369.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 13629.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12980.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15075.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 12980.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13078.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12980.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9659.71 }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11512.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14278.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17782.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16874.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15602.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23296.1 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 12396.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16758.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11403.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 13793.59, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20119.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15576.35, "additional_payer_notes": "120.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Bank Serv Author Deviation", "code_information": [ { "code": "86079", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.4, "discounted_cash": 53.0, "minimum": 41.56, "maximum": 503.818, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 58.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 125.99, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 74.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.07, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 82.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.94 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 111.34, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Supslctv Cath 2Nd+Ord Renl&Acces Artery/S&I Uni", "code_information": [ { "code": "36253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6614.0, "discounted_cash": 5688.0, "minimum": 331.9, "maximum": 6614.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5973.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6257.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4550.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5916.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5859.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 5973.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6614.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5688.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6428.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24241.0, "minimum": 13946.78, "maximum": 44903.45, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 21374.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 26665.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34275.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31514.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 30073.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44903.45 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13946.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 20356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 34397.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 21170.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 25608.48, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 37574.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29089.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 20356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 24968.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 25453.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24241.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16474.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 24241.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 20356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 25209.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24241.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12852.05, "maximum": 13623.173, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12852.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13623.17, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12852.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12852.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13494.65, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10625.19, "maximum": 11262.7014, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11262.7, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11156.45, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Humer Condylr Fx W Manip", "code_information": [ { "code": "24577", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1175.0, "discounted_cash": 1643.0, "minimum": 173.5, "maximum": 1175.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1175.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1175.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1175.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1175.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dx Ophthalmic Us Ant Segment Immersion Uni/Bi", "code_information": [ { "code": "76513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 106.0, "minimum": 65.15, "maximum": 765.4367, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 231.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 254.23 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repsng Intrvas Vc Filtr W Vasc Acs Vssl Rs&I", "code_information": [ { "code": "37192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7948.0, "discounted_cash": 3227.0, "minimum": 1382.1572, "maximum": 7709.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE- SOI : 3", "code_information": [ { "code": "8173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9065.45, "maximum": 9609.377, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9065.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9609.38, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9065.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9065.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9518.72, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Laryngoscopy Flex W Biopsy", "code_information": [ { "code": "31576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6348.95, "discounted_cash": 1819.0, "minimum": 762.0, "maximum": 6158.4815, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2001.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4303.51, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2547.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2729.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3964.79, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1455.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1892.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2820.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2183.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1874.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 762.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3803.24, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2862.31, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2056.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thoracoscopy Diag Bx Of Lung Infiltrate Unilatrl", "code_information": [ { "code": "32607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20995.7, "discounted_cash": 10867.0, "minimum": 1582.0, "maximum": 20995.7, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11410.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11953.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15214.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16300.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8693.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11301.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16844.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13040.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11193.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 11410.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17094.24, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10867.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12279.88, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plc Cath Subselect Art,Neck", "code_information": [ { "code": "36216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2196.0, "minimum": 121.4, "maximum": 2196.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2196.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2196.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2196.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2196.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.74, "discounted_cash": 166.0, "minimum": 35.0, "maximum": 746.74, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 182.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 392.88, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 232.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 249.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 361.96, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 257.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 174.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 347.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.31, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 746.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 166.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.72, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pappa Serum", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.6, "discounted_cash": 15.0, "minimum": 12.04, "maximum": 77.212, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 50.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.33 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nuclear Therapy, Unlisted", "code_information": [ { "code": "79999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1516.76, "discounted_cash": 238.0, "minimum": 145.42, "maximum": 1471.2572, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 262.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 564.18, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 333.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 519.78, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 248.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 369.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 286.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 245.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 498.6, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 375.24, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 269.56, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 174.0, "minimum": 83.33, "maximum": 499.647, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 97.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 83.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 364.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3507.98, "maximum": 3718.4588, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3507.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3718.46, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3507.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3507.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3683.38, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Macroscopic Exam, Parasite", "code_information": [ { "code": "87169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.75, "discounted_cash": 4.0, "minimum": 3.0, "maximum": 81.2375, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 174.0, "minimum": 83.33, "maximum": 499.647, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.92, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 97.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 83.33 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 364.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Knee 4+ View", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 729.25, "discounted_cash": 106.0, "minimum": 22.42, "maximum": 707.3725, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 85.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 93.66 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Abdomen/Pelvis W Contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5817.5, "discounted_cash": 356.0, "minimum": 192.73, "maximum": 5642.975, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.73 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 771.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 771.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 848.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 192.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Electric Current Ther, Iontophoresis Ea 15 Min", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.24, "discounted_cash": 19.0, "minimum": 13.26, "maximum": 162.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 162.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.71, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 87.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 86.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri, Dorsal Spine", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3922.5, "discounted_cash": 243.0, "minimum": 187.2, "maximum": 3804.825, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1156.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1271.15 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.43 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 211.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Debride Skin Sub-Q Tiss Muscle Ea Add 20 Sq Cm", "code_information": [ { "code": "11046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2299.0, "minimum": 399.7961, "maximum": 2299.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2299.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2299.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2299.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Knee Arthroscopy/Surgery - 29881 - OR36029881", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7863.0, "discounted_cash": 3345.0, "minimum": 932.0, "maximum": 7863.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7863.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 932.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Laparoscopy W/Lysis Of Adhesions", "code_information": [ { "code": "58660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27488.0, "discounted_cash": 6180.0, "minimum": 776.0, "maximum": 26663.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6798.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14617.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8652.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9270.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13466.69, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4944.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6427.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9579.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7416.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6365.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6489.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12917.98, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9722.05, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6180.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6983.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 3", "code_information": [ { "code": "7593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16195.58, "maximum": 17167.3148, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16195.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17167.31, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16195.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16195.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17005.36, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytopath Fluids,Smear,Interp", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 388.25, "discounted_cash": 38.0, "minimum": 6.5, "maximum": 376.6025, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 50.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.56 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 79.8, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 2", "code_information": [ { "code": "1792", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31785.07, "maximum": 33692.1742, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 31785.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 33692.17, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 31785.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31785.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33374.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26043.77, "maximum": 27606.3962, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 26043.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 27606.4, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 26043.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26043.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27345.96, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [ { "code": "907", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35496.0, "minimum": 28187.4495, "maximum": 66498.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 31230.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 39046.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50759.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46145.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 44535.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29743.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66498.67 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 29143.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 29743.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 51254.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 30932.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 37416.82, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 55019.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42595.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 29743.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 36561.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 37271.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35496.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32549.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 35496.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 29743.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 37333.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29743.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 35496.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Humer Epicondylr Fx W Manip", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1643.0, "minimum": 173.5, "maximum": 5904.487, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIONS OF UPPER RESPIRATORY TRACT - SOI : 1", "code_information": [ { "code": "1131", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3090.04, "maximum": 3275.4424, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3090.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3275.44, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3090.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3090.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3244.54, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Smp Face 2.6-5.0 Cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.77, "discounted_cash": 205.0, "minimum": 164.088, "maximum": 948.77, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 948.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Brain Flow Imaging Only", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.0, "discounted_cash": 555.0, "minimum": 34.0, "maximum": 319.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 34.07 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 37.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.04 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 319.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Elbow 3+ Vw", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.13, "discounted_cash": 88.0, "minimum": 11.5, "maximum": 490.9461, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 73.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.28 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 151.84, "10th_percentile": 151.84, "90th_percentile": 151.84, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla Class I&Ii Low Hla-A -B -C -Drb1/3/4/5&Dqb", "code_information": [ { "code": "81370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2200.0, "discounted_cash": 402.0, "minimum": 321.696, "maximum": 2134.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 442.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 562.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 603.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 438.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 832.35, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 321.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 933.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 933.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 798.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 465.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 418.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 623.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 321.7 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 482.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 414.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 422.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 482.54, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 482.54, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 495.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 454.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Proc Shoulder Arthrography/Ct/Mri", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.0, "minimum": 33.0, "maximum": 6637.71, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069.0 } ] } ] }, { "description": "Hc Tissue Culture, Bone Marrow", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 887.24, "discounted_cash": 143.0, "minimum": 115.0, "maximum": 860.6228, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 158.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 201.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.56 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 297.55, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 614.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 614.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 526.12 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 222.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 172.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 150.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 172.5 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 172.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9605.0, "minimum": 5862.36, "maximum": 16821.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8558.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10566.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12840.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12487.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11265.92 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8150.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16821.69 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5862.36 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8150.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11758.69 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8476.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10253.37, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14889.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11527.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8150.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9894.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10086.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9605.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7728.01 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9605.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8150.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9443.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8150.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9605.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14409.74 } ] } ] }, { "description": "RESPIRATORY MALIGNANCY - SOI : 4", "code_information": [ { "code": "1364", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16607.06, "maximum": 17603.4836, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16607.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17603.48, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16607.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16607.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17437.41, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12782.0, "minimum": 9713.962, "maximum": 22916.78, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11339.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14060.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17492.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16617.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15347.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10799.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22916.78 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11396.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10799.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16475.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11231.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 13586.15, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19813.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15339.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10799.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13166.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 13421.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12782.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15290.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 12782.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10799.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 12865.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10799.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12782.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13936.28 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29660.0, "minimum": 12596.28, "maximum": 55300.96, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 26119.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 32626.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42212.01 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38558.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 37036.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24875.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55300.96 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 28163.08 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 24875.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 45476.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 25870.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 31293.88, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 45973.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35592.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 24875.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30550.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 31143.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29660.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44039.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 29660.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 24875.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31046.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24875.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29660.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12596.28 } ] } ] }, { "description": "MASTECTOMY PROCEDURES - SOI : 2", "code_information": [ { "code": "3622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19006.27, "maximum": 20146.6462, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19006.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20146.65, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19006.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19006.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19956.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Pulmonary Stress Testing", "code_information": [ { "code": "94618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.2, "discounted_cash": 136.0, "minimum": 8.66, "maximum": 525.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 525.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 525.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS - SOI : 2", "code_information": [ { "code": "2482", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6154.22, "maximum": 6523.4732, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6154.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6523.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6154.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6154.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6461.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 2", "code_information": [ { "code": "4202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5384.4, "maximum": 5707.464, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5384.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5707.46, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5384.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5384.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5653.62, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56160.0, "minimum": 8101.7, "maximum": 106147.07, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 49325.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 61776.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 81023.58 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 73008.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 71089.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 106147.07 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 40200.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 46976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 87125.59 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 48855.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 59096.69, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 87048.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67392.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 46976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 57845.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 58968.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56160.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44376.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 56160.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 46976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 59592.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 56160.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8101.7 } ] } ] }, { "description": "Hc Fine Needle Aspiration Bx W/Ct Gdn Ea Addl", "code_information": [ { "code": "10010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "minimum": 86.95, "maximum": 500.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.0 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 1", "code_information": [ { "code": "1921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8434.23, "maximum": 8940.2838, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8434.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8940.28, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8434.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8434.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8855.94, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Revasc Fem/Pop Art Angiopl/Stnt", "code_information": [ { "code": "37226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52136.0, "discounted_cash": 11347.0, "minimum": 451.1, "maximum": 50571.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11915.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12482.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26838.45, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15887.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17021.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24726.09, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9078.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 451.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17589.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13617.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11688.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 11915.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23718.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17850.58, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11347.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12823.21, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 3", "code_information": [ { "code": "5143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15842.27, "maximum": 16792.8062, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15842.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16792.81, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15842.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15842.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16634.38, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13018.0, "minimum": 8714.31, "maximum": 23368.85, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11546.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14320.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17837.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16923.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15650.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23368.85 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8714.31 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17427.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11436.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 13833.35, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20178.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15621.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13408.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 13669.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13018.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17579.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 13018.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13119.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13018.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dermabrasion segmental face", "code_information": [ { "code": "15781", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2831.0, "discounted_cash": 723.0, "minimum": 492.3109, "maximum": 2831.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2831.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Conversion Biliary Drg Cath, Ext To Int-Ext", "code_information": [ { "code": "47535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9092.0, "discounted_cash": 3660.0, "minimum": 776.0, "maximum": 8819.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4026.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8656.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5124.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5490.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7975.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2928.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3806.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5673.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4392.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3770.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7650.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5757.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4136.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA - SOI : 3", "code_information": [ { "code": "5193", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19022.79, "maximum": 20164.1574, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19022.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 20164.16, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19022.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19022.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19973.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE - SOI : 1", "code_information": [ { "code": "5811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 829.42, "maximum": 879.1852, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 829.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 879.19, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 829.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 829.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 870.89, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13865.0, "minimum": 9450.0, "maximum": 24995.24, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12288.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15252.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19079.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18025.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16739.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11703.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24995.24 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 17113.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11703.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 15330.89 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12171.43, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 14722.75, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21492.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16639.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 11703.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14281.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 14559.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13865.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22873.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 13865.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11703.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14032.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11703.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13865.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Breast W/Out&With Contrast W/Cad Unilateral", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1472.2, "minimum": 220.54, "maximum": 1472.2, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1472.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1472.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1472.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 249.21 } ] } ] }, { "description": "Hc Repair Lip,>1/2 Vert Height", "code_information": [ { "code": "40654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5159.0, "discounted_cash": 1586.0, "minimum": 776.0, "maximum": 5004.23, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1268.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1649.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2458.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1633.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3315.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2495.16, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1792.43, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1665.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1744.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3751.48, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2220.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2379.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3456.21, "additional_payer_notes": "217.89% of Medicare Rates" } ] } ] }, { "description": "THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8964.91, "maximum": 9502.8046, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8964.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9502.8, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8964.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8964.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9413.16, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT - SOI : 4", "code_information": [ { "code": "4404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 71464.35, "maximum": 75752.211, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 71464.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 75752.21, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 71464.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 71464.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 75037.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES - SOI : 2", "code_information": [ { "code": "8162", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5401.64, "maximum": 5725.7384, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5401.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5725.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5401.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5401.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5671.72, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Colonoscopy,Remv Lesn,Snare", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3219.03, "discounted_cash": 1223.0, "minimum": 284.2, "maximum": 6637.71, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 284.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3219.03 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 380.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS - SOI : 4", "code_information": [ { "code": "2814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17218.89, "maximum": 18252.0234, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17218.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18252.02, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17218.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17218.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18079.83, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER RESPIRATORY & CHEST PROCEDURES - SOI : 2", "code_information": [ { "code": "1212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15234.75, "maximum": 16148.835, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15234.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16148.84, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15234.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15234.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15996.49, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bowel Pouch Endo Eval Wash/Brush", "code_information": [ { "code": "44385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 950.0, "minimum": 99.3, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1045.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2248.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1331.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1426.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2071.52, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 760.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 988.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1473.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1140.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 979.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1987.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1495.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1074.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mitochondrial Antibody Each", "code_information": [ { "code": "86381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 373.5, "discounted_cash": 25.0, "minimum": 17.5, "maximum": 362.295, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.68, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 39.8 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 34.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 3", "code_information": [ { "code": "2043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7766.38, "maximum": 8232.3628, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8232.36, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Place Interstitial Dev, Intra-Thoracic, Perq", "code_information": [ { "code": "32553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5331.2, "discounted_cash": 1415.0, "minimum": 289.7375, "maximum": 5171.264, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1485.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1556.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3346.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1981.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2122.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3083.21, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1132.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 289.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 289.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 304.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1471.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2193.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1698.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1457.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1485.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2957.58, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2225.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1415.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1598.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endovasc Taa Rew/O Subcl", "code_information": [ { "code": "33881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12025.4, "minimum": 1582.0, "maximum": 12025.4, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12025.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12025.4 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "KIDNEY TRANSPLANT - SOI : 2", "code_information": [ { "code": "4402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41406.34, "maximum": 43890.7204, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 41406.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 43890.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 41406.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 41406.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 43476.66, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Collect Blood From Implant Venous Access", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.0, "discounted_cash": 136.0, "minimum": 2.68, "maximum": 489.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 489.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nk Cells Total Count", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.04, "discounted_cash": 37.0, "minimum": 30.18, "maximum": 298.7988, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.16 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 78.1, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 39.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.24, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.18 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Suction Lipectomy Trunk", "code_information": [ { "code": "15877", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15123.0, "discounted_cash": 3622.0, "minimum": 1582.0, "maximum": 14669.31, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3803.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3985.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8568.18, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5071.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5434.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7893.81, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2898.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3767.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5615.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4347.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3731.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3803.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7572.17, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5698.8, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4093.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lymphatics & Lymph Glands Imaging", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4212.31, "discounted_cash": 555.0, "minimum": 130.0, "maximum": 4085.9407, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 610.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1312.81, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 777.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 832.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1209.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 444.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 472.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 472.16 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 519.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 577.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 860.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 666.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1160.2, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 873.17, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.0, "discounted_cash": 13.0, "minimum": 10.71, "maximum": 73.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 64.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 54.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.91 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Sinus Tract For Dx W Xray", "code_information": [ { "code": "20501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.0, "minimum": 185.8991, "maximum": 1069.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1069.0 } ] } ] }, { "description": "Hc Inject Diskogram,Lumbar,Ea Level", "code_information": [ { "code": "62290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4596.0, "minimum": 776.0, "maximum": 4458.12, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Chylmd Trach Dna Quant", "code_information": [ { "code": "87492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.99, "discounted_cash": 53.0, "minimum": 39.61, "maximum": 323.0003, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 58.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 53.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 74.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 110.68, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 151.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 129.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 82.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.78 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 53.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.42, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urobilinogen Urine Qual", "code_information": [ { "code": "84578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.44, "discounted_cash": 4.0, "minimum": 3.0, "maximum": 17.8868, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bartonella, Antibody", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.81, "discounted_cash": 10.0, "minimum": 8.14, "maximum": 628.3757, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.21 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.41 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38962.0, "minimum": 3517.57, "maximum": 73148.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 34264.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 42858.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55834.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 50650.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 48989.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32633.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 73148.02 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 3517.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 32633.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 50468.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 33938.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.69, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 60391.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46754.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 32633.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 40131.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 40910.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38962.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7246.27 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 38962.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 32633.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41066.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32633.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38962.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18745.77 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "499", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19026.0, "minimum": 8100.0, "maximum": 34897.38, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16807.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 20929.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26637.67 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24734.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 23371.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34897.38 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 14498.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 16007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13917.92 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16647.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 20137.18, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29491.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22831.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 16007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 19597.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 19977.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19026.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15751.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 19026.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 16007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 19591.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16007.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19026.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS - SOI : 1", "code_information": [ { "code": "0481", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5798.04, "maximum": 6145.9224, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5798.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6145.92, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5798.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5798.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6087.94, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Imag,Acute Venous Thrmbsis,Unilat", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2351.81, "discounted_cash": 555.0, "minimum": 65.0, "maximum": 2281.2557, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 610.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1312.81, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 777.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 832.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1209.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 444.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 350.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 350.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 385.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 577.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 860.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 666.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1160.2, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 873.17, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Splenoportogram", "code_information": [ { "code": "75810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3227.0, "minimum": 39.0, "maximum": 4788.91, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "217.89% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Tongue Lacer,<2.6 Cm", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 456.0, "minimum": 123.6864, "maximum": 711.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 479.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 502.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 711.25, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 639.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 685.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 711.25 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 711.25, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 365.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 711.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 711.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 711.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 711.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 474.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 707.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 548.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 470.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 479.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 711.25, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 711.25, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 711.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 456.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 516.06, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22902.0, "minimum": 7951.95, "maximum": 42334.81, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 20202.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 25193.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32314.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29773.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 28352.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19240.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42334.81 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21162.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 19240.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 30375.57 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 24204.05, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35499.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27483.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 19240.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 23589.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 24048.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26938.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 22902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 19240.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 23767.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19240.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22902.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 7951.95 } ] } ] }, { "description": "Hc Injection For Bladder X-Ray", "code_information": [ { "code": "51600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1224.0, "minimum": 32.0, "maximum": 1224.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1224.0 } ] } ] }, { "description": "Hc Doppler Color Flow Velocity Map (93325)", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.64, "minimum": 16.12, "maximum": 764.9808, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 747.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 747.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 740.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.22 } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 4", "code_information": [ { "code": "5114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38876.43, "maximum": 41209.0158, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 38876.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 41209.02, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 38876.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38876.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 40820.25, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Storage/Year Reprod Tissue", "code_information": [ { "code": "89344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 174.0, "minimum": 88.8629, "maximum": 495.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 411.92, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 379.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 364.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Lo Extrem Art Bilat", "code_information": [ { "code": "93925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2967.25, "discounted_cash": 243.0, "minimum": 119.34, "maximum": 2878.2325, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1137.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1137.54 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1126.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1500-2499G W MAJOR PROCEDURE - SOI : 3", "code_information": [ { "code": "6093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65584.45, "maximum": 69519.517, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 65584.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 69519.52, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 65584.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 65584.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 68863.67, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Xr Fluoro Guidance Cv/Picc Line", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 940.41, "minimum": 46.26, "maximum": 912.1977, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.27 } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.8, "discounted_cash": 174.0, "minimum": 4.14, "maximum": 337.8, "payers_information": [ { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 337.8, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.97, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 337.8, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 337.8, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.33 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fetal Bleed Screen, Kleihauer-Betke", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.0, "discounted_cash": 7.0, "minimum": 6.18, "maximum": 129.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 32.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.18 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8049.0, "minimum": 5651.81, "maximum": 13835.63, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7195.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8854.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10560.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10464.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9266.08 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6852.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13835.63 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6877.47 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6852.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9653.71 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7126.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8620.58, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12476.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9659.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6852.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8291.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8452.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8049.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9124.66 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 8049.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6852.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7767.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6852.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8049.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 5651.81 } ] } ] }, { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS - SOI : 2", "code_information": [ { "code": "1372", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5709.71, "maximum": 6052.2926, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5709.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6052.29, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5709.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5709.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5995.2, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Place Cath In Artery, Slctv Addl 2Nd/3Rd Order, Thoracic/Brachioceph Branch", "code_information": [ { "code": "36218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.0, "minimum": 51.1, "maximum": 448.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 448.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 448.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 448.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 448.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.1 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 448.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 448.0 } ] } ] }, { "description": "Hc Computed Tomography Thorax Lw Dose Lng Ca Scr C-", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.99, "discounted_cash": 106.0, "minimum": 73.38, "maximum": 520.99, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.38 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 520.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 520.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 520.99 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 156.3, "10th_percentile": 156.3, "90th_percentile": 156.3, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12381.0, "minimum": 1582.0, "maximum": 12009.57, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7298.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 7298.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "NEONATE BIRTHWT 500-749G WO MAJOR PROCEDURE - SOI : 1", "code_information": [ { "code": "5911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24444.53, "maximum": 25911.2018, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24444.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 25911.2, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 24444.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24444.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25666.76, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fine Needle Aspiration Bx W/Fluor Gdn Ea Addl", "code_information": [ { "code": "10008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "minimum": 86.95, "maximum": 500.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 500.0 } ] } ] }, { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES - SOI : 3", "code_information": [ { "code": "0263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22341.9, "maximum": 23682.414, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22341.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 23682.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 22341.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22341.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23459.0, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7743", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6572.16, "maximum": 6966.4896, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6572.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6966.49, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6572.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6572.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6900.77, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 7.6-12.5 Cm", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 415.0, "minimum": 310.7489, "maximum": 1786.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 457.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 982.86, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 623.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 905.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 644.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 498.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 428.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 868.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 653.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 469.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Thigh/Knee Abscess,Deep", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13466.2, "discounted_cash": 2969.0, "minimum": 776.0, "maximum": 13062.214, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3266.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7023.14, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4157.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4454.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6470.37, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2375.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3088.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4602.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3563.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3058.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3118.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6206.73, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4671.18, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2969.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3355.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE - SOI : 1", "code_information": [ { "code": "0441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6981.48, "maximum": 7400.3688, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6981.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7400.37, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6981.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6981.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7330.55, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Med Malleolus Fx Wo Manip", "code_information": [ { "code": "27760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 117.5, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SEIZURE - SOI : 1", "code_information": [ { "code": "0531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4615.31, "maximum": 4892.2286, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4615.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4892.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4615.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4615.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4846.08, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL - SOI : 1", "code_information": [ { "code": "6601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5580.45, "maximum": 5915.277, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5580.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5915.28, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5580.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5580.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5859.47, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "IMPLANTABLE HEART ASSIST SYSTEMS- SOI : 1", "code_information": [ { "code": "1611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 108996.48, "maximum": 115536.2688, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 108996.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 115536.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 108996.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 108996.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 114446.3, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Echo Heart Xthoracic,Complete W Doppler", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2899.48, "discounted_cash": 558.0, "minimum": 98.14, "maximum": 2812.4956, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 614.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1321.14, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 782.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 98.14 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1217.16, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1722.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1722.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1705.91 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 869.84, "10th_percentile": 869.84, "90th_percentile": 869.84, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.03 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 865.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 670.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 575.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 586.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 98.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1167.56, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 878.7, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 631.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DRUG ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7762", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4033.64, "maximum": 4275.6584, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4033.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4275.66, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4033.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4033.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4235.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17340.0, "minimum": 10748.67, "maximum": 31661.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15331.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19074.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24167.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22542.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 21204.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14601.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31661.91 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 11473.85 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14601.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21990.62 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15185.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18368.06, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26877.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20808.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14601.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17860.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18207.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17340.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17897.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17340.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14601.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17775.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14601.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17340.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10748.67 } ] } ] }, { "description": "Hc Clsd Treat Nasal Septal Fx", "code_information": [ { "code": "21337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3389.0, "minimum": 43.0, "maximum": 10542.445, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3728.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8016.27, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4745.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5084.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7385.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2711.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3525.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5253.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4067.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3491.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3558.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7084.42, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5331.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3389.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3830.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 3", "code_information": [ { "code": "3853", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9119.3, "maximum": 9666.458, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9119.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9666.46, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9119.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9119.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9575.27, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri Lower Extr W/O Contrast F/U By Contrast", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4841.73, "discounted_cash": 356.0, "minimum": 269.0, "maximum": 4696.4781, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2060.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 16.0, "minimum": 13.168, "maximum": 179.45, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 79.42 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 67.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES - SOI : 2", "code_information": [ { "code": "2282", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10333.63, "maximum": 10953.6478, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10333.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10953.65, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10333.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10333.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10850.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Phys Thrp Eval, Low Complexity, 20 Min", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.75, "discounted_cash": 100.0, "minimum": 63.61, "maximum": 557.5075, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 110.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.61 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 208.52, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 217.91 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 215.81 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 156.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 110.81, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 110.81, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 100.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 113.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Shoulder Superficial", "code_information": [ { "code": "23065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 5997.607, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 836.38, "discounted_cash": 366.0, "minimum": 8.45, "maximum": 836.38, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 403.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 836.38, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 513.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 549.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 798.46, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 293.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 568.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 439.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 377.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 384.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 765.92, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 576.43, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 366.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 414.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Salmonella Antibody", "code_information": [ { "code": "86768", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 13.0, "minimum": 9.1, "maximum": 180.42, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 71.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.55 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEO BWT<500G OR 500-999G & GA<24WKS OR 500-749G W MAJ ANOM OR WOUT LIFE SUSTAINING INTERVENTION- SOI : 4", "code_information": [ { "code": "5894", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2621.83, "maximum": 2779.1398, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2621.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2779.14, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2621.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2621.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2752.92, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OPIOID ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7732", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3749.98, "maximum": 3974.9788, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3749.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3974.98, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3749.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3749.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3937.48, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT 1000-1249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM - SOI : 4", "code_information": [ { "code": "6024", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 117857.26, "maximum": 124928.6956, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 117857.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 124928.7, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 117857.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 117857.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 123750.12, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Smear Complex Stain", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.59, "discounted_cash": 17.0, "minimum": 14.38, "maximum": 130.5523, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.22, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 25.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tee Transcath Maj Vessl Struct Intervention", "code_information": [ { "code": "93355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2435.4, "minimum": 423.5161, "maximum": 2362.338, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1448.42 } ] } ] }, { "description": "Hc Urea-N Clearance Test", "code_information": [ { "code": "84545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 7.0, "minimum": 5.0, "maximum": 91.665, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 24.62 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3662.37, "maximum": 3882.1122, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3662.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3882.11, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3662.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3662.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3845.49, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9993.0, "discounted_cash": 3345.0, "minimum": 1236.0, "maximum": 9693.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7911.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1236.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Abdominal-Venous Shunt", "code_information": [ { "code": "49427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2005.0, "minimum": 348.6695, "maximum": 2005.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2005.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2005.0 } ] } ] }, { "description": "Hc Biopsy Salivary Gland,Needle", "code_information": [ { "code": "42400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 723.0, "minimum": 454.38, "maximum": 2695.55, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Removal Fb", "code_information": [ { "code": "31635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3474.28, "discounted_cash": 1819.0, "minimum": 604.1773, "maximum": 3474.28, "payers_information": [ { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1874.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3474.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2862.31, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2056.18, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1910.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2001.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3474.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2547.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2729.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3474.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1455.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.28 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1892.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2820.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2183.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1819.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open Treat Dist Phalangeal Fx Ea", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 3345.0, "minimum": 178.0, "maximum": 11825.949, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7911.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 832.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytopathology, Forensic", "code_information": [ { "code": "88125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.75, "discounted_cash": 53.0, "minimum": 23.24, "maximum": 231.5875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 58.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 125.99, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 74.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.07, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.64 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 28.79 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 82.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.24 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 111.34, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 765.6, "discounted_cash": 205.0, "minimum": 133.1378, "maximum": 765.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 765.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 765.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 765.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prothrombin Test,Substi,Fractn", "code_information": [ { "code": "85611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 3.0, "minimum": 3.15, "maximum": 38.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.94 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.43 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.15 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.45, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Suction lipectomy lwr extrem", "code_information": [ { "code": "15879", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3829.3, "discounted_cash": 3622.0, "minimum": 665.9153, "maximum": 3829.3, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3803.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2898.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3767.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3731.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3803.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3622.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3829.3, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT - SOI : 1", "code_information": [ { "code": "3151", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10139.74, "maximum": 10748.1244, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10139.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10748.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10139.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10139.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10646.73, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Scan,Limited/Localized F/U Study", "code_information": [ { "code": "76380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1384.1, "discounted_cash": 88.0, "minimum": 54.24, "maximum": 1342.577, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 457.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 457.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 503.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruct Internal Hemorrhoid, Thermal", "code_information": [ { "code": "46930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3338.35, "discounted_cash": 1223.0, "minimum": 580.5391, "maximum": 3338.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prep Wnd Trk/Ar/Lg Ea Add 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.0, "minimum": 11.1296, "maximum": 64.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 64.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 64.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 64.0 } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "507", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17145.0, "minimum": 13262.2637, "maximum": 31287.79, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15160.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 18859.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23882.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22289.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20954.24 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31287.79 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18377.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23843.63 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18163.51, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26575.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20574.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17659.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18002.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22728.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17565.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14438.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17145.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri, Dorsal Spine Combo", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5506.25, "discounted_cash": 356.0, "minimum": 269.0, "maximum": 5341.0625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2060.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE W ECMO - SOI : 4", "code_information": [ { "code": "5834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 443050.69, "maximum": 469633.7314, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 443050.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 469633.73, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 443050.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 443050.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 465203.22, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Perq Xhepatic Portogram", "code_information": [ { "code": "75887", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3227.0, "minimum": 107.5, "maximum": 4788.91, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.95 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Onco (Ovarian) Biochemical Assay Five Proteins", "code_information": [ { "code": "81503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2760.0, "discounted_cash": 897.0, "minimum": 618.3, "maximum": 2677.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 941.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 986.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1255.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1345.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1856.7, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 717.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 932.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1390.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 717.6 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1076.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 923.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 941.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1076.4, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1076.4, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 618.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 897.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1013.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy W Ebus Sampling 1/2 Node", "code_information": [ { "code": "31652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9724.92, "discounted_cash": 3811.0, "minimum": 776.0, "maximum": 9433.1724, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4002.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4192.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9014.55, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5336.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5717.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8305.05, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3049.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3964.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5907.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4573.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3925.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4002.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7966.66, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5995.69, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3811.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4307.09, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Definitive Drug Testing Procedures - G0480 - 30100384", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549.26, "discounted_cash": 114.0, "minimum": 10.185, "maximum": 890.46, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 91.36 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc N.Gonorrhoeae Dna Dir Prob", "code_information": [ { "code": "87590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.0, "discounted_cash": 26.0, "minimum": 18.5, "maximum": 189.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.64, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us Guide Heart Biopsy", "code_information": [ { "code": "76932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 689.61, "minimum": 34.8, "maximum": 668.9217, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.32 } ] } ] }, { "description": "Hc Myelography Lumbar Inj, Lumboscral", "code_information": [ { "code": "62304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5096.0, "discounted_cash": 801.0, "minimum": 641.128, "maximum": 4943.12, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1895.37, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1121.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1746.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1242.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1675.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1260.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 905.59, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cocaine - 80353 - 30100327", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.58, "minimum": 15.19, "maximum": 180.0126, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.16 } ] } ] }, { "description": "Hc Neutralization Test Viral", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 16.0, "minimum": 11.7, "maximum": 174.6, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 63.96 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.53 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "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": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Chest X-Ray 2 Vw", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.25, "discounted_cash": 88.0, "minimum": 14.85, "maximum": 486.2125, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 82.75 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 90.99 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 150.38, "10th_percentile": 150.38, "90th_percentile": 150.38, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Abdomen Angio - C8902 - 61800003", "code_information": [ { "code": "C8902", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2821.69, "discounted_cash": 356.0, "minimum": 217.42, "maximum": 2737.0393, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.9, "discounted_cash": 38.0, "minimum": 30.8, "maximum": 360.743, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.78 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 79.69, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 185.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 158.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 4", "code_information": [ { "code": "3144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25112.38, "maximum": 26619.1228, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 25112.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 26619.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 25112.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25112.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26368.0, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13764.0, "minimum": 9320.9, "maximum": 24801.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12199.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15141.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18931.15 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17894.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16610.04 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11618.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24801.25 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9320.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11618.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 17796.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12083.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 14616.58, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21335.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16517.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 11618.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14177.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 14452.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13764.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10348.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 13764.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11618.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13923.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11618.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13764.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Incision Of Anal Abscess", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6918.0, "discounted_cash": 950.0, "minimum": 728.0, "maximum": 7527.685, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1045.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2248.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1331.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1426.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2071.52, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 760.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 988.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1473.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1140.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 979.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 728.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1987.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1495.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1074.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 1", "code_information": [ { "code": "2631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9665.79, "maximum": 10245.7374, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9665.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 10245.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 9665.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9665.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10149.08, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "SEPTICEMIA & DISSEMINATED INFECTIONS - SOI : 2", "code_information": [ { "code": "7202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7385.06, "maximum": 7828.1636, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7385.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7828.16, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7385.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7385.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7754.31, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established Mod Mdm 30-39 Min - 99214 - 76100009", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 689.0, "minimum": 54.42, "maximum": 668.33, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.49 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11798.58, "maximum": 12506.4948, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11798.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12506.49, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11798.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11798.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12388.51, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "740", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17174.0, "minimum": 12150.0, "maximum": 31343.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15185.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 18891.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23924.72 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22326.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20991.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31343.21 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18954.02 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21437.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18193.83, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26620.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20609.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17689.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18033.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17174.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24134.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17174.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17596.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17174.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6618.84, "maximum": 7015.9704, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6618.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 7015.97, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6618.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6618.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6949.78, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PANCREAS TRANSPLANT - SOI : 3", "code_information": [ { "code": "0063", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 71032.77, "maximum": 75294.7362, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 71032.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 75294.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 71032.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 71032.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 74584.41, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Sigmoidoscopy Flex Lesion/Tumor Remov Snare - 45338 - 75000113", "code_information": [ { "code": "45338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 1223.0, "minimum": 129.3, "maximum": 2904.8, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1345.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2893.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1712.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1835.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2665.58, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 978.69, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1896.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1468.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1260.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1284.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2556.97, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1924.37, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1223.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1382.4, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percut Transhepat Dilat,Bile Duct Strict", "code_information": [ { "code": "74363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4480.69, "minimum": 93.73, "maximum": 4346.2693, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.91 } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 1", "code_information": [ { "code": "4701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4322.32, "maximum": 4581.6592, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4322.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 4581.66, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 4322.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4322.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4538.44, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY - SOI : 2", "code_information": [ { "code": "4432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12989.93, "maximum": 13769.3258, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12989.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 13769.33, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 12989.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12989.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13639.43, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11453.89, "maximum": 12141.1234, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11453.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12141.12, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11453.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11453.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12026.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "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": 560.5, "minimum": 97.471, "maximum": 560.5, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 560.5 } ] } ] }, { "description": "Hc Repair Exten Leg Tendon,Prim,Ea", "code_information": [ { "code": "28208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 3345.0, "minimum": 776.0, "maximum": 11825.949, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7911.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29521.0, "minimum": 7650.0, "maximum": 62603.68, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 25998.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 32473.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42008.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38378.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 36857.84 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55034.22 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 34266.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 24760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 62603.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 25750.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 31148.08, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 45758.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35425.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 24760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 30407.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 30997.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29521.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40703.3 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 29521.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 24760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30897.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24760.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29521.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 8594.98 } ] } ] }, { "description": "Hc Psychiatric Service/Therapy", "code_information": [ { "code": "90899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 588.81, "discounted_cash": 38.0, "minimum": 23.35, "maximum": 571.1457, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.58, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.05, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.25, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Image-Guided Catheter Fluid Collection Drainage", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.0, "discounted_cash": 723.0, "minimum": 87.6456, "maximum": 504.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 504.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 504.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 504.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 504.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 504.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 504.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fibrinolytic Plasminogen - 85415 - 30500076", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 720.0, "discounted_cash": 17.0, "minimum": 13.75, "maximum": 698.4, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 51.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.58, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.72 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mammary Ductogram, Single", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1815.25, "discounted_cash": 243.0, "minimum": 38.98, "maximum": 1760.7925, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.98 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Therapeutic Procd Improve Resp Func, 2 Or > Indiv", "code_information": [ { "code": "G0239", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.18, "discounted_cash": 38.0, "minimum": 23.28, "maximum": 770.3546, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 163.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 161.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 79.8, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sputum Specimen Collection", "code_information": [ { "code": "89220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 174.0, "minimum": 11.57, "maximum": 200.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 191.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 179.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 174.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 196.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Manual Cell Count,Each", "code_information": [ { "code": "85032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 4.0, "minimum": 3.0, "maximum": 59.17, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Prox/Mid Fing Shft Fx Wo Manip Ea", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.0, "discounted_cash": 252.0, "minimum": 49.2137, "maximum": 283.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 283.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 283.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 283.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 283.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 283.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iridotomy/Irridectomy Laser Surg Per Session", "code_information": [ { "code": "66761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2349.35, "discounted_cash": 562.0, "minimum": 408.552, "maximum": 2349.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 618.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1329.79, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 787.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 843.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1225.13, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 449.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2349.35 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 584.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 871.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 674.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 579.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 590.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 795.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1175.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 884.46, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 562.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 635.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fats/Lipids, Feces, Quantitative", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.0, "discounted_cash": 16.0, "minimum": 4.02, "maximum": 318.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.92 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 70.11 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ther Ivnt Cog Funcj Cntct Ea Addl 15 Minutes", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.65, "discounted_cash": 18.0, "minimum": 15.0, "maximum": 120.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 120.65, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.81, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 120.65 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 120.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26891.0, "minimum": 21188.4925, "maximum": 49987.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 23694.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 29580.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38155.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 34958.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 33477.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22566.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49987.02 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 23492.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 22566.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 33253.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 23468.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 28388.28, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 41681.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32269.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 22566.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 27697.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 28235.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26891.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48895.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 26891.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 22566.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 28063.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22566.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26891.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 2", "code_information": [ { "code": "3402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5252.27, "maximum": 5567.4062, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5252.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5567.41, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5252.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5252.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5514.88, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Needle Biopsy Liver,W Othr Proc", "code_information": [ { "code": "47001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1980.74, "minimum": 344.4507, "maximum": 1980.74, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1980.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1980.74 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [ { "code": "815", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9992.0, "minimum": 6209.53, "maximum": 17563.01, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8896.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10991.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13406.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12990.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11762.4 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8472.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17563.01 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6209.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8472.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12212.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10658.72, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15488.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11990.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8472.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10292.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10491.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9992.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8613.32 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9992.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8472.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9860.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8472.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9992.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5406.67, "maximum": 5731.0702, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5406.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5731.07, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5406.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5406.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5677.0, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Place Bile Cath, Cholangio, Perq External", "code_information": [ { "code": "47533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14313.7, "discounted_cash": 3660.0, "minimum": 776.0, "maximum": 13884.289, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4026.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8656.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5124.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5490.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7975.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2928.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3806.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5673.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4392.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3770.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7650.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5757.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4136.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18309.0, "minimum": 14208.6243, "maximum": 33520.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16179.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 20139.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25586.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23801.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 22449.48 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15408.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33520.4 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 18018.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15408.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21018.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 16025.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 19384.27, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28378.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21970.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 15408.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18858.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 19224.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18309.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24113.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 18309.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15408.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 18818.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15408.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18309.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perc Clos,Cong Interatrial Commun W/Impl", "code_information": [ { "code": "93580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73910.7, "discounted_cash": 18740.0, "minimum": 776.0, "maximum": 71693.379, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19677.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20615.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44323.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26237.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28111.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40834.57, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14992.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6568.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6568.56 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 6568.56 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19490.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29048.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22489.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19303.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 19677.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 39170.73, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29479.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18740.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21177.23, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.04, "median_amount": 2.85, "10th_percentile": 2.85, "90th_percentile": 11.41, "count": "1 through 10" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 700.65, "10th_percentile": 700.65, "90th_percentile": 700.65, "count": "1 through 10" } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14161.0, "minimum": 10835.7921, "maximum": 27995.2, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12547.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15578.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19512.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18410.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17120.44 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25563.36 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 24146.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16848.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12428.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15033.35, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21951.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16994.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 11950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14586.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 14870.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14161.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27995.2 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14161.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11950.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14161.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 285.0, "minimum": 61.5, "maximum": 1103.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 314.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 676.24, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 428.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 623.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 443.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 343.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 294.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 597.63, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 449.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1103.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.1, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Cerv Spine Contrast", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4297.0, "discounted_cash": 356.0, "minimum": 269.0, "maximum": 4168.09, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 285.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Thrmbc/Nfs Dial Circ Trluml Balo Angiop S&I", "code_information": [ { "code": "36905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52552.5, "discounted_cash": 11801.0, "minimum": 1582.0, "maximum": 50975.925, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12982.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27912.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16522.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17702.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25715.23, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9441.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5505.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 5505.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 4362.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12274.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18292.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14162.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12155.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24667.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18564.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13336.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4931.0, "discounted_cash": 7418.0, "minimum": 857.5009, "maximum": 4931.0, "payers_information": [ { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1372.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4931.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc M.Avium-Intra Dna Dir Prob", "code_information": [ { "code": "87560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 27.0, "minimum": 18.8, "maximum": 238.2417, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 30.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 56.49, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.83 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucosidase", "code_information": [ { "code": "82963", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 21.0, "minimum": 17.18, "maximum": 255.2652, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.69 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.46, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 104.74 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 89.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.78 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Chest Wo/W Contrast", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5211.13, "discounted_cash": 356.0, "minimum": 285.32, "maximum": 5054.7961, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 472.89 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1874.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 2060.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 501.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 472.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Influenza B Ag If", "code_information": [ { "code": "87275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 12.0, "minimum": 9.8, "maximum": 134.7621, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.18 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.36, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "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": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Coccidioides, Antibody", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.11, "discounted_cash": 11.0, "minimum": 9.176, "maximum": 120.3867, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 58.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Echo Heart,Transesophageal,Complete - C8925 - 48300003", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5181.94, "discounted_cash": 801.0, "minimum": 488.55, "maximum": 5026.4818, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1746.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.13, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1462.55 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1448.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1242.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 825.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1675.04, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1260.63, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 801.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 905.59, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 841.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1895.37, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1121.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytopath Tbs C/V Select", "code_information": [ { "code": "88167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.18, "discounted_cash": 18.0, "minimum": 5.72, "maximum": 153.4346, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 20.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.38, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Carbamazepine Free", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 13.0, "minimum": 10.6, "maximum": 226.98, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.99 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.43, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Gen Seq Analys Solid Organ Neoplasm 5-50 Gene", "code_information": [ { "code": "81445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3150.0, "discounted_cash": 597.0, "minimum": 478.328, "maximum": 3055.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 657.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 837.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 896.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.33 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1237.61, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 478.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1024.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1024.09 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 876.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 507.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 621.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 926.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 478.33 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 717.49, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 615.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 627.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 717.49, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 717.49, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 540.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 597.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 675.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Evasc Rpr Dplmnt Aorto-Bi-Iliac Ndgft", "code_information": [ { "code": "34705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16029.9, "minimum": 1582.0, "maximum": 16029.9, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16029.9 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16029.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 6422.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 5089.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Removal Of Nail Plate, Simple, Ea Ad", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.5, "minimum": 134.3377, "maximum": 772.5, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 772.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 772.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 772.5 } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 4", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14291.15, "maximum": 15148.619, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14291.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15148.62, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14291.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14291.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15005.71, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16092.0, "minimum": 9837.39, "maximum": 29268.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17702.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22340.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20920.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19601.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29268.21 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9837.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18001.29 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 14102.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 17059.11, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24943.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19311.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 13560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16575.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 16897.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16092.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16535.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 16092.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16431.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13560.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16092.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.75, "discounted_cash": 12.0, "minimum": 5.6, "maximum": 173.3875, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.81, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR - SOI : 3", "code_information": [ { "code": "6943", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11546.52, "maximum": 12239.3112, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11546.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 12239.31, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11546.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11546.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12123.85, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Chimerism W/Comp To Baseline W/Cell Selection Ea", "code_information": [ { "code": "81268", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1350.0, "discounted_cash": 260.0, "minimum": 179.8, "maximum": 1309.5, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 286.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 391.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 539.81, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 208.63, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 605.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 517.93 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 404.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 312.95, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 268.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 273.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 312.95, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 312.95, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 260.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Radial Shaft Fx W Manip", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1643.0, "minimum": 145.0, "maximum": 5904.487, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 619.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Irradiation Blood Product, Per Unit", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 38.0, "minimum": 8.0, "maximum": 201.76, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.3, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 83.19, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 79.8, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.06, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Western Blot Test", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 388.06, "discounted_cash": 17.0, "minimum": 13.62, "maximum": 376.4182, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.24 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.25, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 94.43 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 80.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.62 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Platelets Irradiated, Per Unit", "code_information": [ { "code": "P9032", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.0, "discounted_cash": 391.0, "minimum": 68.1, "maximum": 227.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 227.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 227.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 227.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc B-12 Binding Capacity", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 14.0, "minimum": 11.456, "maximum": 169.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.01 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.64, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.23 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 61.82 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.61 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CCMCC", "code_information": [ { "code": "079", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6386.62, "maximum": 18668.69, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6386.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9424.65 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7817.81 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18668.69 } ] } ] }, { "description": "Hc Inject Ductogram/Galactogram", "code_information": [ { "code": "19030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1038.0, "minimum": 180.5082, "maximum": 1038.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1038.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1038.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1038.0 } ] } ] }, { "description": "HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS - SOI : 2", "code_information": [ { "code": "8902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8928.29, "maximum": 9463.9874, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8928.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 9463.99, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 8928.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8928.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9374.7, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2122.25, "discounted_cash": 356.0, "minimum": 16.5, "maximum": 2058.5825, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [ { "code": "061", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25727.0, "minimum": 11031.65, "maximum": 47754.41, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 22675.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 28300.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36451.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33445.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 31982.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21595.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47754.41 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 21195.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 21595.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 34756.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 22459.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 27167.52, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 39877.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 21595.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 26499.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 27013.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25727.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28142.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 25727.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 21595.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 26810.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21595.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25727.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11031.65 } ] } ] }, { "description": "Hc Instill Via Chest Tube For Fibrinolysis, Subq Day", "code_information": [ { "code": "32562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3420.65, "discounted_cash": 641.0, "minimum": 513.04, "maximum": 3420.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 673.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 705.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1516.7, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 897.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1397.33, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 513.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3420.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 994.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 769.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 660.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 673.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1340.39, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1008.78, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 641.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 724.67, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Sho arthrs srg decompression", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5317.96, "minimum": 924.7932, "maximum": 5158.4212, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4816.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4816.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3816.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Nm Parathyroid Planar Imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1790.0, "discounted_cash": 408.0, "minimum": 62.5, "maximum": 1736.3, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 238.51 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 262.26 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xray Femur =>2 Vw", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 739.0, "discounted_cash": 88.0, "minimum": 17.05, "maximum": 716.83, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.05 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 77.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 85.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dress/Debride Burn 5-10% Ttl Med", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 760.0, "discounted_cash": 205.0, "minimum": 132.164, "maximum": 760.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 225.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 485.09, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 287.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 307.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 760.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 446.91, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 760.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 317.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 246.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 428.7, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 322.64, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 760.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 205.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 231.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Intro Cath Dialysis Circ W/Trluml Balo Angiop S&I", "code_information": [ { "code": "36902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25425.0, "discounted_cash": 5818.0, "minimum": 1582.0, "maximum": 24662.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6109.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6400.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13761.32, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8146.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8727.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12678.21, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4654.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 5505.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 5505.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 4362.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6051.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9018.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6982.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5993.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6109.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12161.63, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9152.82, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5818.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6575.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Trluml Coronry Angio/Atherec Addl Art/Brnch", "code_information": [ { "code": "92925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13041.0, "minimum": 1304.1, "maximum": 12649.77, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 } ] } ] }, { "description": "Hc Tissue Culture, Lymphocyte", "code_information": [ { "code": "88230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.0, "discounted_cash": 116.0, "minimum": 93.19, "maximum": 760.48, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 128.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 163.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 241.12, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 567.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 567.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 485.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 180.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 93.19 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.79, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 139.79 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 181.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 116.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.63, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Incision of metatarsal", "code_information": [ { "code": "28308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3152.72, "discounted_cash": 3345.0, "minimum": 548.258, "maximum": 3152.72, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3152.72 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3152.72 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1036.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3152.72, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "2202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17759.63, "maximum": 18825.2078, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17759.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 18825.21, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 17759.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17759.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18647.61, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 4", "code_information": [ { "code": "7934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30340.23, "maximum": 32160.6438, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30340.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 32160.64, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 30340.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30340.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31857.24, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "POSTPARTUM & POST ABORTION DIAGNOSES WO PROCEDURE - SOI : 2", "code_information": [ { "code": "5612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3632.93, "maximum": 3850.9058, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3632.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3850.91, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3632.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3632.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.58, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Repair Of Ankle Ligament - 27695 - OR36027695", "code_information": [ { "code": "27695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9243.0, "discounted_cash": 7418.0, "minimum": 776.0, "maximum": 9243.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8160.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 3670.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2908.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8901.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9243.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8382.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30598.03, "maximum": 32433.9118, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30598.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 32433.91, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 30598.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30598.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32127.93, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Chromosome Karyotype Study", "code_information": [ { "code": "88280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.81, "discounted_cash": 33.0, "minimum": 26.776, "maximum": 328.6457, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.68 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 69.28, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 122.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 104.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 51.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.78 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5481", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3609.23, "maximum": 3825.7838, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3609.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3825.78, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3609.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3609.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3789.69, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc St Eval Speech Sound Prod Languag Comprhns, 15 Min", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1135.01, "discounted_cash": 232.0, "minimum": 180.0, "maximum": 1100.9597, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 244.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 256.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 325.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 481.96, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 186.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 261.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 258.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 360.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 239.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 244.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 256.12, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 256.12, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 232.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 263.11, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 1", "code_information": [ { "code": "0451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6356.73, "maximum": 6738.1338, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6356.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6738.13, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6356.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6356.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6674.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nuclear Therapy, Iv", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1682.0, "discounted_cash": 238.0, "minimum": 37.23, "maximum": 1631.54, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 262.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 564.18, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 333.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.23 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 519.78, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 535.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 535.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 588.74 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.46 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 248.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 369.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 286.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 245.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 498.6, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 375.24, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 238.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 269.56, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 2", "code_information": [ { "code": "3832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5160.35, "maximum": 5469.971, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5160.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5469.97, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5160.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5160.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5418.37, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PERM CARDIAC PACEMAKER IMPLANT WO AMI, HEART FAILURE OR SHOCK - SOI : 2", "code_information": [ { "code": "1712", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14714.83, "maximum": 15597.7198, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14714.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 15597.72, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 14714.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14714.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15450.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mri Breast Without Contrast Material Bilateral", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2721.1, "discounted_cash": 243.0, "minimum": 133.07, "maximum": 2639.467, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.07 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1732.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1732.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1905.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tilt Table Evaluation", "code_information": [ { "code": "93660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2156.75, "discounted_cash": 381.0, "minimum": 305.184, "maximum": 2156.75, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 419.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 902.22, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 534.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 572.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 831.21, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 975.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 975.03 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 965.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2156.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 591.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 457.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2156.75 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 392.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 400.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 797.34, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 600.08, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 381.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.07, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Med Nutr Ther, Group, Ea 30 Min", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 12.0, "minimum": 7.8255, "maximum": 45.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Open/Perq Placement Intravascular Stnt Same 1St", "code_information": [ { "code": "37238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52136.0, "discounted_cash": 11801.0, "minimum": 283.5, "maximum": 50571.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 12982.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27912.08, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16522.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17702.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25715.23, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9441.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12274.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18292.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14162.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12155.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12392.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24667.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18564.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11801.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13336.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8034.0, "minimum": 5852.1647, "maximum": 35476.57, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7181.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8837.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10538.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10444.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9246.36 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6839.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13806.19 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7670.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6839.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9150.98 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7113.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.48, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12453.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9641.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6839.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8275.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8436.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8034.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9389.83 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 8034.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6839.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7751.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6839.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8034.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35476.57 } ] } ] }, { "description": "Hc Mri Bone Marrow", "code_information": [ { "code": "77084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3147.76, "discounted_cash": 243.0, "minimum": 195.144, "maximum": 3053.3272, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 268.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 576.91, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 341.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.09 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 531.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1258.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1258.27 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1383.54 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 253.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 378.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 292.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 256.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 509.84, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 383.71, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 243.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 275.64, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Special Stains,Group I", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.06, "discounted_cash": 53.0, "minimum": 42.616, "maximum": 272.6282, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 58.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 125.99, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 74.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 116.07, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 195.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 166.99 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 82.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.15 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 111.34, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 53.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES - SOI : 2", "code_information": [ { "code": "2542", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6345.24, "maximum": 6725.9544, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6345.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6725.95, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6345.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6345.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6662.5, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18121.0, "minimum": 14055.9144, "maximum": 33160.14, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 16014.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 19933.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25311.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23557.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 22208.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15252.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33160.14 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15125.01 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 15252.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 23577.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15862.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 19187.27, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28087.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21745.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 15252.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 18664.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 19027.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20505.9 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 18121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 15252.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 18616.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15252.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Speech/Hearing Therapy Individual, 90 Min", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.0, "discounted_cash": 78.0, "minimum": 21.7, "maximum": 421.95, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 86.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 109.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 162.14, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 245.24 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 242.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 86.16, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.16, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 78.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 88.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Toes", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 446.25, "discounted_cash": 60.0, "minimum": 20.0, "maximum": 446.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 66.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 142.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 131.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 354.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 350.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 93.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 126.03, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.85, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 446.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Neurobehavioral Status Exam", "code_information": [ { "code": "96116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 716.0, "discounted_cash": 220.0, "minimum": 124.5124, "maximum": 694.52, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 242.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 522.06, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 309.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 331.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 480.97, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 567.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 567.87 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 433.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 342.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 264.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 227.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 461.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 347.23, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 220.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 249.44, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla I Typing 1 Locus Hr", "code_information": [ { "code": "81380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1420.0, "discounted_cash": 177.0, "minimum": 141.8, "maximum": 1377.4, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 186.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 194.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 248.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.45 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 366.89, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 411.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 411.29 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 352.01 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 274.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.8 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 212.7, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.7, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 218.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 177.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.29, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tb Antibiotic Sensitivity", "code_information": [ { "code": "87190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 7.0, "minimum": 5.848, "maximum": 53.35, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Needle Biopsy, Lymph Node(S)", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7683.5, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 7452.995, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 1", "code_information": [ { "code": "7701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2223.99, "maximum": 2357.4294, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 2223.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2357.43, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2223.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2223.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2335.19, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8105.0, "minimum": 5239.46, "maximum": 13943.02, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 7244.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 8916.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10642.91 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 10537.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 9338.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6899.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13943.02 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5239.46 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 6899.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11263.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 7175.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 8679.29, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12563.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9726.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 6899.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 8348.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 8510.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8105.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6855.37 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 8105.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 6899.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 7827.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6899.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8105.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11490.8 } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51222.21, "maximum": 54295.5426, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 51222.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 54295.54, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 51222.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 51222.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 53783.32, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Guide, Gu Dilation", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5631.55, "discounted_cash": 2137.0, "minimum": 77.77, "maximum": 5462.6035, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2243.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2350.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5054.22, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2991.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3205.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.77 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4656.42, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1709.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.44 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2222.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3312.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2201.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2243.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4466.69, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3361.62, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2137.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2414.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prim Perc Mech Thrombectomy, Arterial", "code_information": [ { "code": "37184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9299.0, "discounted_cash": 18740.0, "minimum": 776.0, "maximum": 9299.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 4358.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 4358.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 3453.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9299.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tenotomy Of Hip Tendon", "code_information": [ { "code": "27001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 3345.0, "minimum": 776.0, "maximum": 11825.949, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7911.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brca2 Gene Known Fam Variant", "code_information": [ { "code": "81217", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.0, "discounted_cash": 375.0, "minimum": 74.59, "maximum": 282.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.59 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 158.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 135.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.1 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 282.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Small Bowel Endo To Ileum W Bleed Control", "code_information": [ { "code": "44378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 1961.0, "minimum": 621.7412, "maximum": 3575.28, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2216.77, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2157.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2746.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2942.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1569.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2040.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3040.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2354.09, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2020.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2059.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3085.86, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1961.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Wrist Dislo W Manip", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 104.0, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Dist Fingr Fx W Manip Ea", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 73.0, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 2", "code_information": [ { "code": "3142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10404.72, "maximum": 11029.0032, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10404.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11029.0, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 10404.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10404.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10924.96, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Debride Skin Sub-Q Tiss Each Add 20 Sq Cm", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2299.0, "minimum": 399.7961, "maximum": 2299.0, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2299.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2299.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2299.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "Hc Debride Skin Sub-Q Tiss Musc Bn Ea 20 Sq Cm", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2674.98, "minimum": 465.179, "maximum": 2674.98, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2674.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 } ] } ] }, { "description": "SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT - SOI : 3", "code_information": [ { "code": "3153", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19934.79, "maximum": 21130.8774, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19934.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 21130.88, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 19934.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19934.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20931.53, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repair Vessel Direct Lower Extrem", "code_information": [ { "code": "35226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4430.25, "discounted_cash": 723.0, "minimum": 579.152, "maximum": 4297.3425, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 796.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1712.15, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1577.39, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 579.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1122.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.73, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 745.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 760.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1513.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1138.77, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 723.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 818.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT INFECTIONS - SOI : 2", "code_information": [ { "code": "4632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5329.11, "maximum": 5648.8566, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5329.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5648.86, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5329.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5329.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5595.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17160.0, "minimum": 13274.7447, "maximum": 31317.23, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 15173.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 18876.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23904.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22308.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 20973.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31317.23 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 15783.62 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 21016.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 15029.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 18179.61, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26599.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20592.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 14451.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 17675.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 18018.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19566.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 17160.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 14451.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 17581.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14451.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17160.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26991.7 } ] } ] }, { "description": "Hc Inject Percut Cholangio W Img", "code_information": [ { "code": "47531", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14313.7, "discounted_cash": 3660.0, "minimum": 77.92, "maximum": 13884.289, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4026.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8656.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5124.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5490.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.92 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7975.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2928.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3806.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5673.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4392.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3770.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3843.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7650.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5757.79, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3660.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4136.18, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,No Reprog", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.1, "discounted_cash": 136.0, "minimum": 19.34, "maximum": 485.097, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 302.86 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 231.02 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Heart Infarct Image W Ef", "code_information": [ { "code": "78468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3003.91, "discounted_cash": 555.0, "minimum": 338.39, "maximum": 2913.7927, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 610.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1312.81, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 777.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 832.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1209.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 444.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 445.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 445.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 489.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 577.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 860.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 666.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 582.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1160.2, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 873.17, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 555.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.25, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc M.Tuberculo Dna Dir Probe", "code_information": [ { "code": "87555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 26.0, "minimum": 18.5, "maximum": 238.2417, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 55.64, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 74.13 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14170.0, "minimum": 10248.25, "maximum": 25578.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 12554.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 15587.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19524.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18421.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17130.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25578.94 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10248.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 18878.97 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12435.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15041.91, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21963.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17004.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 11957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 14595.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 14878.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14170.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13219.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14170.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 14360.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11957.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14170.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13271.23 } ] } ] }, { "description": "Hc Mycoplasma Culture", "code_information": [ { "code": "87109", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 389.0, "discounted_cash": 15.0, "minimum": 12.31, "maximum": 377.33, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 74.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 63.42 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Msh2 Gene Dup/Delete Variant", "code_information": [ { "code": "81297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5428.0, "discounted_cash": 213.0, "minimum": 121.37, "maximum": 5265.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 223.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 234.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 298.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 319.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.37 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 441.51, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 258.05 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 220.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 221.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 330.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.64 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 219.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 255.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.96, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 241.03, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 2", "code_information": [ { "code": "4212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6106.82, "maximum": 6473.2292, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6106.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6412.16, "additional_payer_notes": "105% of State Medicaid Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6106.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 6473.23, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 6106.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15969.0, "minimum": 10537.18, "maximum": 29030.92, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 14130.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 17566.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22159.72 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20759.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 19442.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29030.92 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10537.18 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 13457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 19613.18 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 13995.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 16929.41, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24752.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19163.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 13457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 16448.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 16767.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15969.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12117.6 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 15969.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 13457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 16298.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15969.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Molecular Pathology Procedure Level 3", "code_information": [ { "code": "81402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1699.4, "discounted_cash": 150.0, "minimum": 103.6, "maximum": 1648.418, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 165.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 210.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 225.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 311.17, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 120.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 155.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 233.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 120.26 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 154.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 180.4, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.4, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 150.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 169.87, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "718", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12963.0, "minimum": 8550.0, "maximum": 23263.19, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14259.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17757.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16852.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 15579.96 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23263.19 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 10136.41 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 15285.07 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11388.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 13775.6, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20092.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15555.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13352.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 13611.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14446.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 12963.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13060.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12963.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 2", "code_information": [ { "code": "3442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7963.86, "maximum": 8441.6916, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 8441.69, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7963.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8362.05, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS - SOI : 4", "code_information": [ { "code": "6634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15469.57, "maximum": 16397.7442, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15469.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 16397.74, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 15469.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15469.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16243.05, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9890.0, "minimum": 5644.11, "maximum": 17367.29, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8807.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10879.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13256.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12857.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11631.32 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8387.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17367.29 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 5644.11 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8387.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 13299.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8723.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10551.7, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15329.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11868.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8387.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10187.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10384.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9890.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9017.96 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9890.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8387.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9750.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8387.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9890.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W STERILIZATION &OR D&C - SOI : 2", "code_information": [ { "code": "5412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5115.11, "maximum": 5422.0166, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5115.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 5422.02, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 5115.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5115.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5370.87, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 4", "code_information": [ { "code": "7924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38445.56, "maximum": 40752.2936, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 38445.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 40752.29, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 38445.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38445.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 40367.84, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Metacarpal Fx Wo Manip Ea", "code_information": [ { "code": "26600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1059.0, "discounted_cash": 252.0, "minimum": 69.5, "maximum": 1059.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1059.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OTHER AFTERCARE & CONVALESCENCE - SOI : 1", "code_information": [ { "code": "8621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3107.99, "maximum": 3294.4694, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3107.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3294.47, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3107.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3107.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.39, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Emg, Needle, Two Limbs", "code_information": [ { "code": "95861", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 730.0, "discounted_cash": 136.0, "minimum": 22.5, "maximum": 730.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 149.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 321.67, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 296.35, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 730.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 730.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 693.05 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.21, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.28, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 136.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 153.69, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14818.0, "minimum": 7650.0, "maximum": 26822.56, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 13122.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 16300.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20474.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19263.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 17963.76 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26822.56 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 13013.22 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 12497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16880.08 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 12997.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 15721.86, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22968.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17781.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 12497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 15262.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 15559.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14818.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17900.7 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 14818.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 12497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 15058.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12497.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14818.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sigmoidoscopy Flex Dir Submuc Inject", "code_information": [ { "code": "45335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2637.09, "discounted_cash": 950.0, "minimum": 83.4, "maximum": 2637.09, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1045.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2248.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1331.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1426.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2071.52, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 760.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 988.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1473.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1140.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 2637.09 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 979.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 998.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1987.12, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1495.5, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 950.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1074.31, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Renal Biopsy Perq", "code_information": [ { "code": "50200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7683.5, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 7452.995, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Wrist 2 Vw", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.61, "discounted_cash": 88.0, "minimum": 11.5, "maximum": 417.6917, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 65.71 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 72.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7817.1, "discounted_cash": 1996.0, "minimum": 776.0, "maximum": 7582.587, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2096.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2195.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4721.38, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2794.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2994.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4349.78, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1597.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2076.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3094.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2395.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2056.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4172.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3140.25, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1996.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2255.84, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Needle Asp Bx, Single Lobe", "code_information": [ { "code": "31629", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2308.0, "discounted_cash": 3811.0, "minimum": 401.3612, "maximum": 2308.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2308.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2308.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2308.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 2308.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2308.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.63, "discounted_cash": 16.0, "minimum": 13.0, "maximum": 286.7611, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.61 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 69.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "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": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Extrem Unilat", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5087.81, "discounted_cash": 1609.0, "minimum": 22.5, "maximum": 4935.1757, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1689.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1770.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3806.07, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2253.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2413.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3506.5, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1287.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1673.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2494.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1931.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1657.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1689.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3363.63, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.46, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1609.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1818.51, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Upper Extrem W Contrast - C8934 - 61800013", "code_information": [ { "code": "C8934", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2737.56, "discounted_cash": 356.0, "minimum": 217.42, "maximum": 2655.4332, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1338.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 1471.86 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 217.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Humeral Supracondylar Fx Wo Manip", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 949.69, "discounted_cash": 252.0, "minimum": 123.5, "maximum": 949.69, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 949.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us, Breast Unilat Complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 725.44, "discounted_cash": 106.0, "minimum": 53.43, "maximum": 703.6768, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 252.75, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 149.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.43 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.86, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 165.5 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 181.97 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 326.45, "10th_percentile": 217.63, "90th_percentile": 326.45, "count": "1 through 10" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.64 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 165.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 223.37, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.11, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 106.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Renal Cyst Xlumbar+Contrst", "code_information": [ { "code": "74470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1815.25, "discounted_cash": 558.0, "minimum": 26.5, "maximum": 1760.7925, "payers_information": [ { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 580.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 865.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 670.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 575.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 586.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1167.56, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 878.7, "additional_payer_notes": "157.30% 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": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 631.23, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 586.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 614.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1321.14, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 782.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 837.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1217.16, "additional_payer_notes": "217.89% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES - SOI : 3", "code_information": [ { "code": "4413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27584.84, "maximum": 29239.9304, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27584.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 29239.93, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 27584.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27584.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28964.08, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Myelography Post Fossa", "code_information": [ { "code": "70010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3147.76, "discounted_cash": 356.0, "minimum": 39.0, "maximum": 3053.3272, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 392.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 843.49, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 499.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 777.1, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.34 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.92, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 552.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 374.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 745.44, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.02, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 356.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.01, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Corpora Cavern Xray", "code_information": [ { "code": "54230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.0, "minimum": 76.3421, "maximum": 439.0, "payers_information": [ { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 439.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 439.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 439.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 439.0 } ] } ] }, { "description": "Hc Cervical Cancer Screening - G0476 - 31100074 - 31100074", "code_information": [ { "code": "G0476", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 35.0, "minimum": 28.072, "maximum": 237.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.21 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 72.63, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 81.89 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 70.09 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.65, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Family Psytx W/Patient", "code_information": [ { "code": "90847", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 911.0, "discounted_cash": 181.0, "minimum": 110.62, "maximum": 883.67, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 199.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 429.16, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 254.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 395.38, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 281.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 190.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 379.27, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 285.44, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 181.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.05, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Quantitative Screen, Metals", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.8, "discounted_cash": 21.0, "minimum": 17.568, "maximum": 117.176, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 24.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.35 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.46, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 110.37 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 94.47 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 34.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.57 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16770.07, "maximum": 17776.2742, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16770.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 17776.27, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 16770.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16770.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17608.57, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "NEO BWT<500G OR 500-999G & GA<24WKS OR 500-749G W MAJ ANOM OR WOUT LIFE SUSTAINING INTERVENTION- SOI : 2", "code_information": [ { "code": "5892", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 126491.12, "maximum": 134080.5872, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 134080.59, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 126491.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 132815.68, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42697.0, "minimum": 6979.7, "maximum": 80315.25, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 37536.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 46967.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61305.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55506.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 53789.2 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35748.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80315.25 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 56613.53 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 35748.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 59083.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 37178.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 44971.86, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 66181.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 51237.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 35748.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 43978.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 44832.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42697.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70050.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 42697.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 35748.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45090.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35748.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42697.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 6979.7 } ] } ] }, { "description": "Hc Unlisted Ct Procedure", "code_information": [ { "code": "76497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 88.0, "minimum": 54.24, "maximum": 406.4494, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 97.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.83, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 212.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 233.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 137.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 185.94, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 88.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.52, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Mt-Phal Toe Disloc W Anes", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1643.0, "minimum": 83.0, "maximum": 5904.487, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1808.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3887.87, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2301.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2465.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.87, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1709.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2548.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1972.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1693.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1726.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3435.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.87, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1643.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1857.6, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.06, "discounted_cash": 5.0, "minimum": 4.6, "maximum": 97.0582, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.39 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 20.87 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Treatment Of Ankle Fracture - 27814 - OR36027814", "code_information": [ { "code": "27814", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11433.0, "discounted_cash": 7418.0, "minimum": 776.0, "maximum": 11433.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 8160.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11433.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10385.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11127.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11433.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5934.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7714.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11433.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8901.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7640.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 7789.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11433.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11433.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7418.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8382.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Repair Of Leg Tendon Each", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9993.0, "discounted_cash": 3345.0, "minimum": 776.0, "maximum": 9693.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3679.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7911.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4683.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7288.53, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3478.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5184.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4014.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3445.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3512.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6991.55, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5261.83, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3345.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3779.91, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us, Ob < 14 Wks, Add'L Fetus", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.0, "minimum": 21.98, "maximum": 562.6, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 243.38 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 267.61 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.84 } ] } ] }, { "description": "Hc Biopsy Soft Tissue Back,Deep", "code_information": [ { "code": "21925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1688.0, "minimum": 776.0, "maximum": 5997.607, "payers_information": [ { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3529.1, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2656.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1907.97, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1772.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1857.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3993.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2363.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2532.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3679.01, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1350.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2523.13 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2523.1 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1999.25 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3634.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1756.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2617.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2026.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 1688.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1739.12, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Hc Htlv-I Antibody", "code_information": [ { "code": "86687", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.09, "discounted_cash": 9.0, "minimum": 7.27, "maximum": 191.1773, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40.96 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 35.06 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Repair of foot tendon", "code_information": [ { "code": "28200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3042.0, "discounted_cash": 3345.0, "minimum": 529.0038, "maximum": 3042.0, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2676.04, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3042.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3042.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3042.0, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.38, "discounted_cash": 24.0, "minimum": 17.5, "maximum": 185.6386, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.05, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 115.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 98.48 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.25, "discounted_cash": 17.0, "minimum": 14.0, "maximum": 200.0625, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 83.48 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 71.45 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "104.00% 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": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "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 All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10143.0, "minimum": 3931.93, "maximum": 17853.99, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 9029.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 11158.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13628.21 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13187.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11957.28 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8599.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17853.99 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 7452.99 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8599.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 12166.19 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8943.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10817.83, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15723.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12172.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8599.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 10448.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 10651.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10143.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9899.05 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 10143.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8599.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 10023.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8599.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10143.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3931.93 } ] } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES- SOI : 4", "code_information": [ { "code": "3214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38585.59, "maximum": 40900.7254, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 38585.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 40900.73, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 38585.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38585.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 40514.87, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ercp Remov Calculi/Debris Biliary/Pancreas Duct", "code_information": [ { "code": "43264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4742.61, "discounted_cash": 3941.0, "minimum": 776.0, "maximum": 4742.61, "payers_information": [ { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4729.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4059.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4453.94, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4335.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3153.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4099.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urinalysis, Auto, W/Scope", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 3.0, "minimum": 2.536, "maximum": 200.79, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.56, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 11.77 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Dx/Thr Paravrt Facet Jnt Img Lumb/Sac 1St Lvl", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 904.0, "minimum": 555.5496, "maximum": 3194.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 949.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 994.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2138.52, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1265.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1356.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1970.2, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1376.25 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1376.3 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1090.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 940.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1401.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 931.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 949.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1889.93, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1422.36, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 904.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1021.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ORGANIC MENTAL HEALTH DISTURBANCES - SOI : 4", "code_information": [ { "code": "7574", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23235.23, "maximum": 24629.3438, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 23235.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 24629.34, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 23235.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23235.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24396.99, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Repr Wnd Cplx Face/Hnd/Ft/Gent 1.1-2.5 Cm", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1786.94, "discounted_cash": 415.0, "minimum": 310.7489, "maximum": 1786.94, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 457.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 982.86, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 623.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 905.51, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 644.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 498.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 428.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 436.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 868.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 653.72, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1786.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 415.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 469.61, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13515.0, "minimum": 9615.26, "maximum": 24323.21, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 11981.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 14867.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18566.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17570.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 16289.88 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11411.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24323.21 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 9615.26 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 11411.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 16772.78 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 11867.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 14355.16, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20949.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16218.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 11411.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 13921.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 14191.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13515.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13543.8 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 13515.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 11411.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 13655.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11411.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13515.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc Chro Add - 92944 - 48100200", "code_information": [ { "code": "92944", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10388.0, "minimum": 1038.8, "maximum": 10076.36, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 } ] } ] }, { "description": "Hc Assay Of Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.19, "discounted_cash": 11.0, "minimum": 9.536, "maximum": 188.3643, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 51.59 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 44.16 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.54 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "ORBIT AND EYE PROCEDURES - SOI : 2", "code_information": [ { "code": "0732", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11150.84, "maximum": 11819.8904, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11150.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 11819.89, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 11150.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11150.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11708.38, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "Hc Speech/Hearing Therapy, Group, 30 Min", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.0, "discounted_cash": 24.0, "minimum": 10.0, "maximum": 364.72, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.4, "additional_payer_notes": "A Indicator - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 87.2 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 86.32 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 38.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.06, "additional_payer_notes": "113.00% of Medicare Rates" }, { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 34.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9509.0, "minimum": 7051.8181, "maximum": 16636.36, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8473.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10460.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12698.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12362.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 11141.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16636.36 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 8532.57 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 9829.73 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8392.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 10152.02, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14739.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11411.23, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 8069.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9794.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 9984.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9509.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11199.5 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 9509.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 8069.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 9339.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9509.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Deglycerolized, Per Unit", "code_information": [ { "code": "P9039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 945.0, "discounted_cash": 311.0, "minimum": 190.93, "maximum": 916.65, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 342.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 736.64, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 436.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 467.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 678.66, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 322.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 322.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 322.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 482.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 320.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 327.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 651.01, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.95, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 351.96, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16524.2, "discounted_cash": 3227.0, "minimum": 22.5, "maximum": 16028.474, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 3550.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7634.31, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4519.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4841.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7033.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2582.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3357.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5003.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3873.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3324.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 3389.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6746.86, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5077.68, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3647.62, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Partial Hosp Prog Service", "code_information": [ { "code": "G0129", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.0, "minimum": 59.8216, "maximum": 333.68, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 180.0 } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 93912.0, "minimum": 17177.84, "maximum": 178583.22, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 82384.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 103304.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 136315.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 122086.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 119601.8 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 78461.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 178583.22 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 86768.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 78461.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 124053.12 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 81600.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 98704.94, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 145565.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 112695.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 78461.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 96730.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "case rate", "standard_charge_dollar": 98608.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 93912.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 143991.0 }, { "payer_name": "UBH", "plan_name": "UBH (VA CCN)", "methodology": "case rate", "standard_charge_dollar": 93912.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare Optum", "methodology": "case rate", "standard_charge_dollar": 78461.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 100259.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 78461.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 93912.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17177.84 } ] } ] }, { "description": "Hc Clsd Treat Ulnar Xf Prox End Wo Manip", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 252.0, "minimum": 100.0, "maximum": 999.15, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 277.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 549.45, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 573.44 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 573.4 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 454.38 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 390.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 302.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 264.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 527.07, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 396.67, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 252.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.95, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp,Biopsy", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4742.61, "discounted_cash": 3941.0, "minimum": 776.0, "maximum": 4742.61, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 4335.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 1582.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3153.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 2981.88 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "case rate", "standard_charge_dollar": 2981.9 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 2362.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4099.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4729.85, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 3500.0 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4059.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 4138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4742.61, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3941.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4453.94, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - 80337 - 30100422", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 782.95, "minimum": 14.75, "maximum": 759.4615, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 } ] } ] }, { "description": "Hc Phospholipid Neutraliz, Hexagonal Phospholipid", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.0, "discounted_cash": 17.0, "minimum": 14.38, "maximum": 245.41, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.22, "additional_payer_notes": "Laboratory - 206.99% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 66.9 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NJ Medicaid HMO", "plan_name": "NJ Medicaid HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Replacement Gastro-Jejunostomy Tube Percutaneous", "code_information": [ { "code": "49452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4295.95, "discounted_cash": 927.0, "minimum": 109.78, "maximum": 4167.0715, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 1019.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2192.94, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1298.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1390.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.78 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2020.34, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "case rate", "standard_charge_dollar": 1642.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1642.14 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 1642.14 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.4 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1437.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1112.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 973.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1938.02, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1458.55, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2040.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 927.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1047.77, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ureteral Reflux Study", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1972.0, "discounted_cash": 408.0, "minimum": 50.0, "maximum": 1912.84, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 449.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 966.57, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 572.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 613.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 890.49, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 326.95, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 430.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 430.78 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 473.67 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 633.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 420.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 854.21, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 642.88, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 408.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 461.82, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iv Infu, Therap/Proph/Diagn, Init, Ea Add Hr", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1039.13, "discounted_cash": 47.0, "minimum": 12.29, "maximum": 1007.9561, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.19, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 67.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 104.28, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 59.04, "median_amount": 13.03, "10th_percentile": 13.03, "90th_percentile": 13.03, "count": "1 through 10" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 74.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.43, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 100.03, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.28, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 47.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.08, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood, L/R, Froz/Degly/Wash Per Unit", "code_information": [ { "code": "P9054", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1377.9, "discounted_cash": 263.0, "minimum": 30.0, "maximum": 1336.563, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 624.11, "additional_payer_notes": "236.50% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "fee schedule", "standard_charge_dollar": 395.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 574.99, "additional_payer_notes": "217.89% of Medicare Rates" }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "fee schedule", "standard_charge_dollar": 211.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Commercial HMO PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 273.0 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "fee schedule", "standard_charge_dollar": 273.0 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 409.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan", "plan_name": "Spartan Plan", "methodology": "fee schedule", "standard_charge_dollar": 277.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 551.56, "additional_payer_notes": "209.01% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.1, "additional_payer_notes": "157.30% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 298.2, "additional_payer_notes": "113.00% of Medicare Rates" } ] } ] }, { "description": "OPEN CRANIOTOMY FOR TRAUMA- SOI : 3", "code_information": [ { "code": "0203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29765.74, "maximum": 31551.6844, "payers_information": [ { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29765.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicaid", "methodology": "case rate", "standard_charge_dollar": 31551.68, "additional_payer_notes": "106% of State Medicaid Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicaid", "methodology": "case rate", "standard_charge_dollar": 29765.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29765.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31254.03, "additional_payer_notes": "105% of State Medicaid Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "394", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9285.0, "minimum": 6778.06, "maximum": 17301.16, "payers_information": [ { "payer_name": "Ally-Align Medicare", "plan_name": "Ally-Align Medicare", "methodology": "case rate", "standard_charge_dollar": 8277.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Auto Insurance", "plan_name": "Auto Insurance", "methodology": "case rate", "standard_charge_dollar": 10214.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial (05-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12370.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12071.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Exchange", "methodology": "case rate", "standard_charge_dollar": 10854.12 }, { "payer_name": "Health Partners Plan", "plan_name": "Health Partners Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7883.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Highmark", "plan_name": "Highmark Commercial (02-01-2024 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16206.81 }, { "payer_name": "Humana Military Tricare", "plan_name": "Humana Military Tricare", "methodology": "case rate", "standard_charge_dollar": 6778.06 }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC Medicare", "methodology": "case rate", "standard_charge_dollar": 7883.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Independence Blue Cross", "plan_name": "IBC PPACA", "methodology": "case rate", "standard_charge_dollar": 11770.75 }, { "payer_name": "Keystone", "plan_name": "Keystone First Medicare", "methodology": "case rate", "standard_charge_dollar": 8198.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Luminary", "plan_name": "Luminary Medicare", "methodology": "case rate", "standard_charge_dollar": 9917.14, "additional_payer_notes": "125.80% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14392.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11142.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "PA Health & Wellness", "plan_name": "PA Health & Wellness Medicare & Duals", "methodology": "case rate", "standard_charge_dollar": 7883.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Providers Partner Health Plan", "plan_name": "Provider Partners Health Plan", "methodology": "case rate", "standard_charge_dollar": 9564.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Spartan",